Patients leaving the emergency department without being seen by a physician: a retrospective database analysis

QUESTIONS UNDER STUDY: To describe characteristics of patients leaving the emergency department (ED) before being seen by a physician and to identify factors associated with a greater risk of leaving the ED too early. METHODS: Design: retrospective database analysis. Setting: emergency department (ED) of an urban teaching hospital admitting 60,000 patients per year. Study subjects: all patients older than 18 years admitted to the ED over one year. Collected data: patient's and ED visit characteristics. RESULTS: Among the 57,645 patients admitted, we identified 2,413 patients (4.2%) who left without being seen (LWBS). LWBS patients were more likely to be male (odds ratio [OR] 1.13, 95% confidence interval [CI 95%]: 1.03-1.23), single (OR 1.12, CI 95%: 1.01-1.23), unemployed (OR 1.27, CI 95%: 1.13-1.44), dependent on welfare (OR 1.29, CI 95%: 1.12-1.50) or Muslim (OR 1.19, CI 95%: 1.00-1.42). LWBS patients were also more likely to present with less acute emergency triage levels. As complaints, alcohol and/or other substance abuse (OR 6.08, CI 95%: 5.04-7.34), neurological problems (OR 2.23, CI 95%: 1.88-2.64) or dermatological problems (OR 1.63, CI 95%: 1.37-1.94) were over-represented in this population. Patients admitted at weekends (OR 1.27, 95% CI: 1.16-1.39) and/or during the night (OR = 2.67, 95% C: 2.35-3.02) also were at higher risk of leaving the ED prematurely. CONCLUSIONS: LWBS patients share some characteristics and a better understanding of these characteristics as well as time and logistic issues could ease to implement strategies to reduce premature leaving from the ED.