Aftercare forPatients who did not Wait for Treatment at the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/198336
Title:
Aftercare forPatients who did not Wait for Treatment at the Emergency Department
Abstract:
[ENA Annual Conference 2011 - Research Presentation]Patients who did not wait for Treatment

Purpose: Emergency department crowding results in long waits for patients before evaluation and patients leaving without being seen (LWBS). This has been associated with possible adverse events from delayed diagnosis or treatment. The purpose of this study was to determine the frequency of patients LWBS, reasons for leaving, and factors that might prevent patients from leaving.

Design: A prospective, pair-matched case-control study, using database searches and a telephonic follow-up. Controls were matched for time of presentation to control for the variation in staffing and ED crowding. Follow-up interviews were conducted 3 to 8 days after the ED visit. Measures of crowding were collected using the number of patients registered around the index LWBS and compare these with a random sample of controls. The study was approved by the research ethics committee.

Setting: Two EDs in the Netherlands: one urban, level 1 teaching hospital and trauma center with an ED patient census of ±50,000 per year, and one rural ED with 22,000 patients per year.

Participants: All patients LWBS between November 1, 2010 and February 28, 2011. Patients who left against medical advice were excluded in this study.

Methods: Data were collected from the hospital’s electronic database. During the follow-up, patients LWBS were asked their current health status, how long they waited, reasons they left, whether they received any medical care during the follow-up and what could have prevented them from leaving. Analysis included distribution of demographic variables, chi-square tests for the categorical variables and two-tailed student’s t-test to compare means for the normally distributed numerical variables. For waiting times to triage and length of stay, the Mann Whitney U Test was used and medians were presented.

Results: During the study period, 23,780 patients registered, of whom 169 (0.71%) patients LWBS. In the urban hospital, no difference in mean number of patients registered during index LWBS case and control (16.6 vs. 15.2, p=0.081). In the rural hospital, the influence of crowding on number of patients LWBS was significant (10.2 vs. 7.8, p=0.031). As triage category reduced in urgency, patients were more likely to LWBS. 16 % of patients LWBS were defined as urgent or very urgent. One patient was hospitalized with an illness related to the first ED visit. The number one reason patients LWBS in our study was long waits. Compared to their controls, patients who LWBS were younger and more likely to have self-referred. No differences were found in sex, number of ED visits, having a GP and in insurance status. Controls had significant more hospital admissions in the previous year. 52% of the respondents sought medical care after leaving the ED within 48 hours. We found no correlation between acuity and obtaining medical care.

Implications: Patients indicated that they highly appreciated the calls and advices given during the follow-up, so we continued to follow-up patients LWBS and expanded the target population to patients who left AMA, as part of the continuous quality improvement process in the ED.
Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleAftercare forPatients who did not Wait for Treatment at the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198336-
dc.description.abstract[ENA Annual Conference 2011 - Research Presentation]Patients who did not wait for Treatment<br/><br/>Purpose: Emergency department crowding results in long waits for patients before evaluation and patients leaving without being seen (LWBS). This has been associated with possible adverse events from delayed diagnosis or treatment. The purpose of this study was to determine the frequency of patients LWBS, reasons for leaving, and factors that might prevent patients from leaving. <br/><br/>Design: A prospective, pair-matched case-control study, using database searches and a telephonic follow-up. Controls were matched for time of presentation to control for the variation in staffing and ED crowding. Follow-up interviews were conducted 3 to 8 days after the ED visit. Measures of crowding were collected using the number of patients registered around the index LWBS and compare these with a random sample of controls. The study was approved by the research ethics committee.<br/><br/>Setting: Two EDs in the Netherlands: one urban, level 1 teaching hospital and trauma center with an ED patient census of ±50,000 per year, and one rural ED with 22,000 patients per year.<br/><br/>Participants: All patients LWBS between November 1, 2010 and February 28, 2011. Patients who left against medical advice were excluded in this study.<br/><br/>Methods: Data were collected from the hospital’s electronic database. During the follow-up, patients LWBS were asked their current health status, how long they waited, reasons they left, whether they received any medical care during the follow-up and what could have prevented them from leaving. Analysis included distribution of demographic variables, chi-square tests for the categorical variables and two-tailed student’s t-test to compare means for the normally distributed numerical variables. For waiting times to triage and length of stay, the Mann Whitney U Test was used and medians were presented. <br/><br/>Results: During the study period, 23,780 patients registered, of whom 169 (0.71%) patients LWBS. In the urban hospital, no difference in mean number of patients registered during index LWBS case and control (16.6 vs. 15.2, p=0.081). In the rural hospital, the influence of crowding on number of patients LWBS was significant (10.2 vs. 7.8, p=0.031). As triage category reduced in urgency, patients were more likely to LWBS. 16 % of patients LWBS were defined as urgent or very urgent. One patient was hospitalized with an illness related to the first ED visit. The number one reason patients LWBS in our study was long waits. Compared to their controls, patients who LWBS were younger and more likely to have self-referred. No differences were found in sex, number of ED visits, having a GP and in insurance status. Controls had significant more hospital admissions in the previous year. 52% of the respondents sought medical care after leaving the ED within 48 hours. We found no correlation between acuity and obtaining medical care. <br/><br/>Implications: Patients indicated that they highly appreciated the calls and advices given during the follow-up, so we continued to follow-up patients LWBS and expanded the target population to patients who left AMA, as part of the continuous quality improvement process in the ED.<br/>en_GB
dc.date.available2011-12-21T12:46:11Z-
dc.date.issued2011-12-21T12:46:11Z-
dc.date.accessioned2011-12-21T12:46:11Z-
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