Address of institution at which the work was carried out: Royal Children's Hospital Emergency Department, Flemington Road, Parkville, Vic. 3052, Australia.
Leaving the paediatric emergency department without being seen: Understanding the patient and the risks
Article first published online: 12 OCT 2011
© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 48, Issue 1, pages 10–15, January 2012
How to Cite
Ng, Y. and Lewena, S. (2012), Leaving the paediatric emergency department without being seen: Understanding the patient and the risks. Journal of Paediatrics and Child Health, 48: 10–15. doi: 10.1111/j.1440-1754.2011.02187.x
- Issue published online: 18 JAN 2012
- Article first published online: 12 OCT 2011
- Accepted for publication 27 May 2011.
- attitude to health;
- consumer satisfaction;
- emergency service;
- patient dropout;
Aim: The aim of this study is to examine the left-without-being-seen (LWBS) patient population of a tertiary paediatric emergency department (ED) to provide quality assurance and risk management data.
Methods: This is a prospective observational study of patients who LWBS after presenting to the Royal Children's Hospital Melbourne ED between July and November 2005. Information was collected from electronic databases and follow-up telephone interviews performed by the principal investigator 3–5 days after the presentation.
Results: Over the 17-week study period, 7.6% of attendances were recorded as having LWBS. These patients and their presentations resembled the general ED population in many respects. However, there were several significant differences, particularly in relation to age, insurance status, mode of arrival, referral status, arrival time and illness severity. Most families (74%) indicated they would have been equally happy to visit a general practitioner instead had one been available. Prolonged waiting times and recognition that their child's illness was not severe were the most frequent reasons for leaving. Most parents subsequently accessed alternate health care or were planning to do so, and the majority stated their child's illness was improving. Parents maintained a surprisingly positive attitude to their ED presentation.
Conclusion: The individual risks associated with leaving the ED before a child has been medically assessed are small. However, when multiplied several thousandfold as a function of the frequency of LWBS patients, the chance of serious adverse events becomes real. Potential risk management strategies include decreasing absolute LWBS numbers by addressing ED overcrowding and providing alternate sources for non-urgent care.