Patients Left Without Being Seen in the Emergency Department – A Retrospective Observational Patient Record Study

Abstract BackgroundThe share of patients leaving the emergency department without being seen by a physician (LWBS) is an important efficacy marker of emergency departments around the world. It has not however, been of special research interest in the Nordic countries. In this study, we assessed the LWBS rate in Kanta-Häme Central Hospital, in Hämeenlinna, Finland. Secondarily, we gathered information of LWBS patients along with all ED patients.MethodsIn this retrospective observational patient record study, our primary aim was to assess the LWBS rate of all patient visits (n = 41,631) over a 12-month period in a mid-sized Finnish secondary hospital ED. Alongside, we gathered specific information, such as age, gender, time of day and year for attendance, reason for attendance, return to healthcare and mortality after 7 and 30 days and after one year to show characteristics of LWBS patients. We present data and hourly distribution of the LWBS patients against all patient visits to the ED.ResultsA total of 305 LWBS cases were identified, leading to an LWBS rate of 0.73 %. Most LWBS took place during afternoon hours, when the ED was most crowded and waiting times were longest. Among LWBS patients, minor traumas and non-specific pain were the most common reasons for attending. Mortality among LWBS patients was naught (0.0 %) over a one-year follow-up.ConclusionsThe LWBS rate in the Kanta-Häme Central Hospital ED was low. Higher LWBS rate coincided with rush hours and longer waiting times. The proportion of minor traumas was greater than in some earlier studies. These results support the implementation of a fast track line for minor traumas in the ED.

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Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

Acta Médica Portuguesa ◽

10.20344/amp.9962 ◽

2018 ◽

Vol 31 (2) ◽

pp. 109 ◽

Cited By ~ 2

Author(s):

Rodrigo Sousa ◽

Cátia Correia ◽

Rita Valsassina ◽

Sofia Moeda ◽

Teresa Paínho ◽

...

Keyword(s):

Emergency Department ◽

Medical Care ◽

Patient Outcomes ◽

Waiting Time ◽

Waiting Times ◽

Adverse Outcomes ◽

Decision To Leave ◽

Left Without Being Seen ◽

Number Of Patients ◽

Control Study

Introduction: Children who visit emergency departments and leave without being seen represent a multifactorial problem. We aimed to compare the sociodemographic characteristics of children who left and of those who did not leave, as well as to evaluate parental reasoning, subsequent use of medical care and patient outcome.Material and Methods: This was a prospective case-control study of a random sample of children who left without being seen and their matched controls from an emergency department during a three-month period. We performed a phone questionnaire to obtain information concerning reasons for leaving, patient outcomes and general feedback.Results: During the study period, 18 200 patients presented to the emergency department, of whom 92 (0.5%) left without being seen. Fifty-five (59.8%) completed the questionnaire and there were 82 controls. The most common reasons for leaving were ‘excessive waiting time’ (92.7%) and ‘problem could wait’ (21.8%). A significantly higher number of patients who left sought further medical care (78.2% vs 11%) but they did not experience higher levels of unfavourable outcomes.Discussion: The waiting time seems to be the major factor that drives the decision to leave. The fact that parents felt safe in leaving and the low level of adverse outcomes highlights the low-acuity nature of the majority of patients who leave.Conclusion: Reducing the waiting times may be the logical strategic mean to decrease the rates of patients who leave without being seen. However, our data seems to indicate that the concerns surrounding clinical outcome after leaving may be partly unwarranted.

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The impact of coronavirus disease 2019 (COVID-19) on alternatives to opioids protocol for opioid reduction in emergency department

10.22514/sv.2021.243 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Length Of Stay ◽

Pain Control ◽

The United States ◽

Left Without Being Seen ◽

Significant Difference ◽

Opioid Administration ◽

One Year ◽

The Impact

The United States (US) is in the midst of both an opioid epidemic and COVID-19 pandemic. The Alternatives to Opioids (ALTO) approach is a useful strategy of utilizing non-opioid options as the first-line pain therapy in the emergency department (ED). Since the COVID-19 pandemic began, more than 40 states have reported a rise in opioid-related deaths. Since there is a potential increasing need for pain management due to limited outpatient resources during the COVID-19 pandemic, it is unclear whether the COVID-19 has affected the effectiveness of the ALTO protocol in reducing opioid administration in the ED. To investigate the impact of COVID-19 on the usage of the ALTO protocol for opioid reduction, this retrospective cohort study was performed to compare patients receiving pain medication in an urban ED during the COVID-19 pandemic (March to August 2020) and patients during the same period from one year prior. The primary outcome was the change in ED opioid administration and out-patient opioid prescriptions. All opioid dosages were converted to morphine milligram equivalents (MME) for data analysis. Secondary outcomes included changes in ALTO medication use, patient satisfaction with pain control, ED length of stay, and rate of left without being seen (LWBS). The mean prescribed MME per discharged patient visit was significantly lower in the COVID-19 pandemic group (3.16 ± 0.31 versus 7.72± 0.31, p < 0.001). There was no significant difference in ED opioid administration, patient satisfaction with pain control, ED length of stay, and rate of LWBS between both groups. In conclusion, during the COVID-19 pandemic, the ALTO protocol can reduce out-patient opioid usage without changing opioid administration in the ED.

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Characterization of severe hypoglycemia episodes evaluated in the emergency department of a central hospital

Endocrine Abstracts ◽

10.1530/endoabs.35.p389 ◽

2014 ◽

Author(s):

Cesar Esteves ◽

Manuel Celestino Neves ◽

Rui Baldaia ◽

Joao Sa ◽

Davide Carvalho

Keyword(s):

Emergency Department ◽

Severe Hypoglycemia ◽

Central Hospital

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Faculty Opinions recommendation of Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11812956.12909054 ◽

2011 ◽

Author(s):

Patrick Ray

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Hospital Admission ◽

Waiting Times ◽

Population Based ◽

Short Term ◽

Short Term Mortality

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Geriatrische revalidatiezorg na triage op de Spoedeisende Hulp: Patiëntkarakteristieken en revalidatie-uitkomsten

Tijdschrift voor Gerontologie en Geriatrie ◽

10.36613/tgg.1875-6832/2019.01.02 ◽

2019 ◽

Keyword(s):

Emergency Department ◽

Residential Care ◽

Functional Decline ◽

Care Facility ◽

Geriatric Rehabilitation ◽

Residential Care Facility ◽

Successful Group ◽

Geriatrische Revalidatiezorg ◽

One Year ◽

Single Contact

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

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Using body temperature and variables commonly available in the EHR to predict acute infection: a proof-of-concept study showing improved pretest probability estimates for acute COVID-19 infection among discharged emergency department patients

Diagnosis ◽

10.1515/dx-2021-0020 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Carl T. Berdahl ◽

An T. Nguyen ◽

Marcio A. Diniz ◽

Andrew J. Henreid ◽

Teryl K. Nuckols ◽

...

Keyword(s):

Emergency Department ◽

Body Temperature ◽

Acute Infection ◽

Time Of Day ◽

Pretest Probability ◽

Absolute Difference ◽

Proof Of Concept ◽

Easy Method ◽

Concept Study ◽

Probability Estimates

Abstract Objectives Obtaining body temperature is a quick and easy method to screen for acute infection such as COVID-19. Currently, the predictive value of body temperature for acute infection is inhibited by failure to account for other readily available variables that affect temperature values. In this proof-of-concept study, we sought to improve COVID-19 pretest probability estimation by incorporating covariates known to be associated with body temperature, including patient age, sex, comorbidities, month, and time of day. Methods For patients discharged from an academic hospital emergency department after testing for COVID-19 in March and April of 2020, we abstracted clinical data. We reviewed physician documentation to retrospectively generate estimates of pretest probability for COVID-19. Using patients’ COVID-19 PCR test results as a gold standard, we compared AUCs of logistic regression models predicting COVID-19 positivity that used: (1) body temperature alone; (2) body temperature and pretest probability; (3) body temperature, pretest probability, and body temperature-relevant covariates. Calibration plots and bootstrap validation were used to assess predictive performance for model #3. Results Data from 117 patients were included. The models’ AUCs were: (1) 0.69 (2) 0.72, and (3) 0.76, respectively. The absolute difference in AUC was 0.029 (95% CI −0.057 to 0.114, p=0.25) between model 2 and 1 and 0.038 (95% CI −0.021 to 0.097, p=0.10) between model 3 and 2. Conclusions By incorporating covariates known to affect body temperature, we demonstrated improved pretest probability estimates of acute COVID-19 infection. Future work should be undertaken to further develop and validate our model in a larger, multi-institutional sample.

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Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

Journal of Palliative Care ◽

10.1177/08258597211003359 ◽

2021 ◽

pp. 082585972110033

Author(s):

Elizabeth Hamill Howard ◽

Rachel Schwartz ◽

Bruce Feldstein ◽

Marita Grudzen ◽

Lori Klein ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

End Of Life Care ◽

Older Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Life Care ◽

Emergency Medicine Physician ◽

Medicine Physician ◽

One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

Journal of Patient Experience ◽

10.1177/23743735211011404 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110114

Author(s):

Andrew Nyce ◽

Snehal Gandhi ◽

Brian Freeze ◽

Joshua Bosire ◽

Terry Ricca ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Patient Experience ◽

Waiting Times ◽

Hospital Length ◽

Short Length ◽

Hospital Length Of Stay ◽

Patient’S Experience ◽

Discharged Patients ◽

The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

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