Introduction: Uncompleted visits in the emergency department (UEDC) are a patient safety concern. The purpose of this study was to further investigate risk factors for UEDC, describing socio-demographic characteristics but also access and hospital characteristics both of those left AMA and those who LWBS.
Methods: this was a retrospective case–control study on administrative anonymous data using a population-based emergency department database.
Results: overall, 9,147,415 patients attended the EDs of Veneto Region from 2011 to 2015. Rate of UEDC was 28,7‰, composed by slightly higher rate of AMA compared to LWBS (15,3‰ Vs 13,4‰). Age, sex, citizenship, residence are sociodemographic factors associated with UEDC and also the characteristics of access as admission mode, the type of referring, the emergency level, waiting time of visit and the type of complaint, finally also the characteristics of the structure as type and volume of hospital could be associate with UEDC.
Conclusion: Patients with Uncompleted Emergency Department Care both those who leave AMA and LWBS greatly differs from other not UEDC. These results are important for planning and staffing health services. Decision makers should identify and target factors to minimise walkouts from public hospital emergency departments.
Weiss SJ, Ernst AA, Derlet R, King R, Bair A, Nick TG. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med. 2005; 23:288–94. https://www.sciencedirect.com/science/article/pii/S0735675705000847?via%3Dihub
Asaro PV, Lewis LM, Boxerman SB. Emergency department overcrowding: analysis of the factors of renege rate. Acad Emerg Med. 2007; 14:157–62.
Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. JAMA. 1991; 266:1085–90.
Bindman AB, Grumbach K, Keane D, Rauch L, Luce JM. Consequences of queing for care at a public hospital emergency department. JAMA. 1991; 266:1091–6.
Goodacre S, Webster A. Who waits longest in the emergency department and wh o leaves without being seen? EmergMed J. 2003; 22(2):93–6.
Polevoi SK, Quinn JV, Kramer NR. Factors associated with patients who leave without being seen. AcadEmergMed. 2005; 12:232–6. https://onlinelibrary.wiley.com/doi/abs/10.1197/j.aem.2004.10.029
Rowe BH, Channan P, Bullard M, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med. 2006; 13: 848–52.
Ding R, McCarthy ML, Li G, Kirsch TD, Jung JJ, Kelen GD. Patients who leave without being seen: their characteristics and history of emergency department use. Ann Emerg Med. 2006; 48:686–93.
General Accounting Office. Hospital Emergency Departments— Crowded Conditions Varyamong Hospitals and Communities. GAO-03-460. Washington, DC: United States General Accounting Office, 2003.
McMullan JT, Veser FH. Emergency department volume and acuity as factors in patients leaving without treatment. South Med J. 2004; 97:729–33.
Vieth TL, Rhodes KV. The effect of crowding on access and quality in an academic ED. Am J Emerg Med. 2006; 24:787–94.)
Mohsin M, Forero R, Ieraci S, Bauman AE, Young L, Santiano N. A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emerg Med J. 2007; 24:175–9.
Johnson M, Myers S, Wineholt J, Pollack M, Kusmiesz AL. Patients who leave the emergency department without being seen. J Emerg Nurs. 2009; 35:105–8.
Hung GR, Chalut D. A consensus-established set of important indicators of pediatric emergency department performance. Pediatr Emerg Care. 2008; 24:9–15.
Pines JM: The left without being seen rate: an imperfect measure of emergency department crowding. Acad Emerg Med 2006, 13(7):807–807.
Arendt KW, Sadosty AT, Weaver AL, Brent CR, Boie ET: The left-without being- seen patients: what would keep them from leaving? Ann Emerg Med 2003, 42(3):317–323.
Kelen GD, Scheulen JJ, Hill PM: Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. AcadEmergMed 2001, 8(11):1095–1100.
Hsia RY, Asch SM, Weiss RE, Zingmond D, Liang LJ, Han W, McCreath H, Sun BC: Hospital determinants of emergency department left without being seen rates. Ann Emerg Med 2011, 58(1):24–32. e3.
Sainsbury SJ: Emergency patients who leave without being seen: are urgently ill or injured patients leaving without care? Mil Med 1990, 155(10):460–464.
Pham JC, Ho GK, Hill PM, McCarthy ML, Pronovost PJ: National study of patient, visit, and hospital characteristics associated with leaving an emergency department without being seen: predicting LWBS. Acad Emerg Med 2009, 16(10):949–955.
Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N: The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2008, 16(1):1–10.
Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA: Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. Brit Med J 2011, 342:D2983]
Liao HC, Liaw SJ, Hu PM, Lee KT, Chen CM, Wang FL: Emergency department patients who leave without being seen by a doctor: the experience of a medical center in northern Taiwan. Chang Gung Med J 2002, 25(6):367–373.
Kennedy M, MacBean CE, Brand C, Sundararajan V, Mc DTD: Review article: leaving the emergency department without being seen. Emerg Med Australas 2008, 20(4):306–313.
Burt CW, McCaig LF: Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003–04. Adv Data 2006, 376(376):1–24.
Kronfol RN, Childers K, Caviness AC: Patients who leave our emergency department without being seen: the Texas Children's hospital experience. Pediatr Emerg Care 2006, 22(8):550.
Baibergenova A, Leeb K, Jokovic A, Gushue S: Missed opportunity: patients who leave emergency departments without being seen. Healthc Policy 2006, 1(4):35–42.
Hobbs D, Kunzman SC, Tandberg D, Sklar D: Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med 2000, 18(7):767–772.
Fernandes CM, Price A, Christenson JM: Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997, 15(3):397–399.
DM MdS del 17 dicembre 2008 “Istituzione del sistema informativo per il monitoraggio delle prestazioni erogate nell’ambito dell’assistenza sanitaria in emergenza-urgenza.”, pubblicato sulla G.U. Serie Generale n. 9 del 13 gennaio 2009
McCarthy ML, Zeger SL, Ding R, Levin SR, Desmond JS, Lee J, Aronsky D: Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med 2009, 54(4):492–503. e494.
Trzeciak S, Rivers E: Emergency department overcrowding in the united states: an emerging threat to patient safety and public health. Emerg Med J 2003, 20(5):402.
Hoot NR, Aronsky D: Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008, 52(2):126–136. e121.
Saia M, Buja A, Mantoan D, Bertoncello C, Baldovin T, Callegaro G, Baldo V. Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database. Ann Ist Super Sanita. 2014;50(4):357-62.