Characteristics of patients who leave without being seen: comparing with those who do not leave
Main Article Content
Abstract
The percent of patients leaving without been seen by a doctor (LWBS) is often seen as a quality indicator of care. In this longitudinal study, we compare the behaviour over time of two groups of patients: the LWBS group composed by patients who did at least one LWBS visit, with the no-LWBS group containing the remaining individuals. We analysed their low acuity visits over a period of 3.5 years and search for the most frequent sequences of use of the Emergency departments in the city of Sherbrooke, Quebec. The LWBS visits represent a high percent of low acuity visits (14%) but they are generated by a low percent of the population (10.7%). The LWBS group generated 6.68 visits per person versus 3.13 visits in the no-LWBS group. The LWBS patients are young, 36 years old on average, and live in city areas either materially or socially deprived. Analysis of temporal sequences for all users revealed that patients’ conditions are being treated in the ED, instead of being followed up with a GP or a family doctor. Temporal sequences also revealed that a member of the LWBS group will likely repeat an LWBS visit within a week. Mental disorders, respiratory and digestive system problems are more frequent in the LWBS group than in the no-LWBS group and this may indicate chronic situations poorly managed. As there is no monetary incentive for the hospitals in Quebec to reduce the LWBS rate, we propose to establish a recall system that will direct chronic patients to external clinics already in service in the hospitals.
Article Details
How to Cite
ZUBIETA, Lourdes; FERNANDEZ-PEÑA, Jose Ramon; GOMES, Heitor Murilo.
Characteristics of patients who leave without being seen: comparing with those who do not leave.
Medical Research Archives, [S.l.], v. 5, n. 4, apr. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1124>. Date accessed: 19 apr. 2024.
Keywords
left without being seen (LWBS), low acuity triage, patient trajectories
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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Cuong Pham J, Ho GK, Peter M. Hill PM et al. National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS Acad Emerg Med. 2009 Oct;16(10):949-55. doi: 10.1111/j.1553-2712.2009.00515.x.
Geirsson OP, Gunnarsdottir OS, Baldursson J, et al. Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study. Emerg Med J 2013; 30:662-668 doi:10.1136/emermed-2012-201129
Gilligan P, Joseph D, Winder S, et al. DNW—“Did Not Wait” or “Demographic Needing Work”: a study of the profile of patients who did not wait to be seen in an Irish emergency department Emerg Med J 2009; 26:780-782 doi:10.1136/emj.2008.063388
Goodacre S, WebsterA. Who waits in the emergency department and who leaves without being seen? Emerg Med J 2005; 22:93–96 https://dx.doi.org/10.1136%2Femj.2003.007690
Guttmann A, Schull MJ, Vermeulen MJ, et al. Association between waiting times and short term mortality and hospital admission after departure from emergency Study. Emerg Med J 2012; 29:550-553 doi:10.1136/emj.2010.109074
Fournier-Viger P, Gomariz- Peñalver A, Gueniche, TA, et al. SPMF: a Java Open-Source Pattern Mining Library. Journal of Machine Learning Research (JMLR) 2014,15: 3389-3393. http://www.philippe-fournier-viger.com/spmf/index.php?link=algorithms.php
Fraser J, Atkinson P, Gedmintas A, et al. A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment. CJEM 1–8 2016. doi: 10.1017/cem.2016.375.
Hsia RY, Asch SM, Weiss RE et al. Hospital Determinants of Emergency Department Left Without Being Seen Rates”. Annals of Emergency Medicine. 2011; 58:1, 24 – 32
Jones P, Jones J, O'Brien K, Lee-Poy M. Predictors of Low-Acuity Emergency Department Use by Patients Enrolled in a Family Health Team. CJEM 2015, 17:04, 359-366.
Kurowski EM et al. Return visit characteristics among patients who leave without being seen from a pediatric ED. American Journal of Emergency Medicine 2012, 30: 7, 1019 – 1024.
Leung AK, Whatley DS, Gao D, Duic M. Impact of process improvement on measures of emergency department efficiency. CJEM 2016. 17:1-10 https://dx.doi.org/10.1017/cem.2016.382
Murilo Gomes H, Ribeiro de Carvalho D, Zubieta L, Barddal JP, Malucelli A. On the Discovery of Time Distance Constrained Temporal Association Rules. 22nd International Conference on Neural Information Processing (ICONIP 2015), November 9-12, Istanbul, Turkey. Proceedings, Part II, 510-519. http://dx.doi.org/10.1007/978-3-319-26535-3_58
O'Keeffe F, Cronin S, Gilligan P, et al. Did Not Wait Patient Management Strategy (DNW PMS) department: population based cohort study from Ontario, Canada. BMJ 2011; 342:d2983
Parekh KP, Russ S, Amsalem D, et al. Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana. BMC Emergency Medicine 2013, 13:10 http://www.biomedcentral.com/1471-227X/13/10)
Roberge D, Pineault R, Larouche D. The Continuing Saga of Emergency Room Overcrowding: Are We Aiming at the Right Target? HEALTHCARE POLICY 2010; 5-03; 27-39.
Zubieta L, Fernandez-Peña JR. A retrospective study on emergency visits in two hospitals in Sherbrooke, Canada. Journal of Hospital Administration 2014; 3-4, 61-70.
Cuong Pham J, Ho GK, Peter M. Hill PM et al. National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS Acad Emerg Med. 2009 Oct;16(10):949-55. doi: 10.1111/j.1553-2712.2009.00515.x.
Geirsson OP, Gunnarsdottir OS, Baldursson J, et al. Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study. Emerg Med J 2013; 30:662-668 doi:10.1136/emermed-2012-201129
Gilligan P, Joseph D, Winder S, et al. DNW—“Did Not Wait” or “Demographic Needing Work”: a study of the profile of patients who did not wait to be seen in an Irish emergency department Emerg Med J 2009; 26:780-782 doi:10.1136/emj.2008.063388
Goodacre S, WebsterA. Who waits in the emergency department and who leaves without being seen? Emerg Med J 2005; 22:93–96 https://dx.doi.org/10.1136%2Femj.2003.007690
Guttmann A, Schull MJ, Vermeulen MJ, et al. Association between waiting times and short term mortality and hospital admission after departure from emergency Study. Emerg Med J 2012; 29:550-553 doi:10.1136/emj.2010.109074
Fournier-Viger P, Gomariz- Peñalver A, Gueniche, TA, et al. SPMF: a Java Open-Source Pattern Mining Library. Journal of Machine Learning Research (JMLR) 2014,15: 3389-3393. http://www.philippe-fournier-viger.com/spmf/index.php?link=algorithms.php
Fraser J, Atkinson P, Gedmintas A, et al. A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment. CJEM 1–8 2016. doi: 10.1017/cem.2016.375.
Hsia RY, Asch SM, Weiss RE et al. Hospital Determinants of Emergency Department Left Without Being Seen Rates”. Annals of Emergency Medicine. 2011; 58:1, 24 – 32
Jones P, Jones J, O'Brien K, Lee-Poy M. Predictors of Low-Acuity Emergency Department Use by Patients Enrolled in a Family Health Team. CJEM 2015, 17:04, 359-366.
Kurowski EM et al. Return visit characteristics among patients who leave without being seen from a pediatric ED. American Journal of Emergency Medicine 2012, 30: 7, 1019 – 1024.
Leung AK, Whatley DS, Gao D, Duic M. Impact of process improvement on measures of emergency department efficiency. CJEM 2016. 17:1-10 https://dx.doi.org/10.1017/cem.2016.382
Murilo Gomes H, Ribeiro de Carvalho D, Zubieta L, Barddal JP, Malucelli A. On the Discovery of Time Distance Constrained Temporal Association Rules. 22nd International Conference on Neural Information Processing (ICONIP 2015), November 9-12, Istanbul, Turkey. Proceedings, Part II, 510-519. http://dx.doi.org/10.1007/978-3-319-26535-3_58
O'Keeffe F, Cronin S, Gilligan P, et al. Did Not Wait Patient Management Strategy (DNW PMS) department: population based cohort study from Ontario, Canada. BMJ 2011; 342:d2983
Parekh KP, Russ S, Amsalem D, et al. Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana. BMC Emergency Medicine 2013, 13:10 http://www.biomedcentral.com/1471-227X/13/10)
Roberge D, Pineault R, Larouche D. The Continuing Saga of Emergency Room Overcrowding: Are We Aiming at the Right Target? HEALTHCARE POLICY 2010; 5-03; 27-39.
Zubieta L, Fernandez-Peña JR. A retrospective study on emergency visits in two hospitals in Sherbrooke, Canada. Journal of Hospital Administration 2014; 3-4, 61-70.