Patients who leave the Emergency Department without being seen. Has COVID-19 affected this phenomenon?
Keywords:
emergency department, LWBS(left without being seen), Covid-19, Waiting timeAbstract
Background and aim: Patients who present to an Emergency Department (ED) and leave without being seen by a physician represent a safety concern because they may become severely ill and experience adverse events as a result of lacking or delayed ED treatment. Prior to the COVID-19 outbreak, the increasing number of patients accessing care through the ED in Italy and throughout the world has had implications for health policies.
Methods: A retrospective cohort study that included all ED visits from 1st January 2013 to 31st December 2018 in the Perugia University Hospital has been carried out.
Results: During the 5 years investigated 26,344 out of 300,372 (8.77%) patients who attended the ED left the triage area before being seen with an average of 439 patients per month. The same phenomenon has been analysed from February to October 2020. During these 9 months there were a total of 1,824 out of 30,990 (5.88%) patients who left the ED without being seen with an average of 202 per month. The latter value is one third lower than the one related to the period investigated prior to the COVID-19 outbreak.
Conclusions: Such investigation could help to differentiate actual essential demand from non-essential demand within the ED, which could inform quality-improvement policies. Several strategies could be implemented to lower the proportion of patients who leave the department without being seen. Reorganising the activities in the ED with different paths should be implemented with the aim of reducing waiting times and in turn patients’ satisfaction.
References
Cohen BA, Wessling EG, Serina PT, Cruz DS, Kim HS, McCarthy DM, Loftus TM. Emergency department operations in a large health system during COVID-19. Am J Emerg Med 2021;41:241-243. doi:10.1016/j.ajem.2020.05.097
Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, Gundlapalli AV; National Syndromic Surveillance Program Community of Practice. Impact of the COVID-19 Pandemic on Emergency Department Visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69(23):699-704. doi:10.15585/mmwr.mm6923e1
Levaggi R, Montefiori M, Persico L. Speeding up the clinical pathways by accessing emergency departments. Eur J Health Econ 2020;21(1):37-44. doi: 10.1007/s10198-019-01107-5.
Venkatesh AK, Janke A, Rothenberg C, Chan E, Becher RD. National trends in emergency department closures, mergers, and utilization, 2005-2015. PLoS One 2021;16(5):e0251729. doi: 10.1371/journal.pone.0251729.
Pak A, Gannon B. Do access, quality and cost of general practice affect emergency department use? Health Policy 2021;125(4):504-511. doi: 10.1016/j.healthpol.2021.01.003.
Mataloni F, Colais P, Galassi C, Davoli M, Fusco D. Patients who leave Emergency Department without being seen or during treatment in the Lazio Region (Central Italy): Determinants and short term outcomes. PLoS One 2018;13(12):e0208914. doi: 10.1371/journal.pone.0208914.
Rathlev NK, Visintainer P, Schmidt J, Hettler J, Albert V, Li H. Patient Characteristics and Clinical Process Predictors of Patients Leaving Without Being Seen from the Emergency Department. West J Emerg Med 2020;21(5):1218-1226. doi: 10.5811/westjem.2020.6.47084.
Kennedy M, MacBean CE, Brand C, Sundararajan V, McD Taylor D. Review article: leaving the emergency department without being seen. Emerg Med Australas 2008;20(4):306-313. doi:10.1111/j.1742-6723.2008.01103.x
Sørup CM, Jacobsen P, Lundager Forberg J. Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures. Scand J Trauma Resusc Emerg Med 2013;21:62. doi: 10.1186/1757-7241-21-62.
Sheraton M, Gooch C, Kashyap R. Patients leaving without being seen from the emergency department: A prediction model using machine learning on a nationwide database. J Am Coll of Emerg Physicians Open 2020;1(6): 1684–1690. https://doi.org/10.1002/emp2.12266.
Yakobi M, Cheng Md D. Retrospective Analysis of the Effects of the COVID-19 Pandemic on the Emergency Department Walk-Out Rate in an Acute Care Community Hospital During the USA National Lockdown. Cureus 2021;13(7):e16660. doi: 10.7759/cureus.16660.
Spencer S, Stephens K, Swanson-Biearman B, Whiteman K. Health Care Provider in Triage to Improve Outcomes. J Emerg Nurs 2019;45(5):561-566. doi:10.1016/j.jen.2019.01.008
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Copyright (c) 2022 Gian Domenico Giusti, Maria Rosaria Cozzolino, Alessio Gili, Andrea Ceccagnoli, Monia Ceccarelli, Paolo Groff, Nicola Ramacciati
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