Patients who leave our emergency department without being seen - The Texas Children's Hospital Experience

Objectives: As the number of individuals seeking emergency care has increased during the last decade, the challenges facing emergency departments (EDs) have grown. These include overcrowding, increasing wait times, and an increasing number of patients who leave without being seen by a medical professional. We sought to describe the clinical characteristics of patients leaving the Texas Children's Hospital (TCH) ED without being seen during 1.5-year period as well as the predictors of further treatment received by these patients. Methods: We prospectively conducted a simple random sample of patients who left the TCH ED without being seen to determine their demographic and clinical characteristics as well as their clinical outcomes. Frequencies and measures of central tendency were used to describe the study population. Univariate and multivariate analyses were conducted to determine the predictors of receiving treatment elsewhere after leaving the TCH ED. Results: Almost all study patients identified a primary care provider (PCP), and the most patients who left sought care with their PCP within 8 hours. Almost half the patients arrived during the busy evening hours between 7 and 11 Pm, and the median wait time before leaving was 3 hours. Almost half of the patients reported receiving treatment elsewhere, and 4% were admitted elsewhere. Those ill longer than 24 hours were almost 3 times as likely to receive treatment elsewhere. Almost all patients were clinically better by the time of telephone follow-up, and no patient had died. Conclusions: Our findings suggest that most patients who leave the ED without being seen have PCPs and seek care elsewhere after they leave. However, most patients are not sick enough to warrant admission elsewhere and probably could have waited to see their PCP rather than come to the ED.