National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS

Authors

  • Julius Cuong Pham MD, PhD,

    1. From the Department of Emergency Medicine (JCP, GKH, PMH, MLM), the Department of Anesthesia and Critical Care Medicine (JCP, PJP), and the Department of Surgery (JCP, PJP), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • George K. Ho MD,

    1. From the Department of Emergency Medicine (JCP, GKH, PMH, MLM), the Department of Anesthesia and Critical Care Medicine (JCP, PJP), and the Department of Surgery (JCP, PJP), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • Peter M. Hill MD,

    1. From the Department of Emergency Medicine (JCP, GKH, PMH, MLM), the Department of Anesthesia and Critical Care Medicine (JCP, PJP), and the Department of Surgery (JCP, PJP), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • Melissa L. McCarthy ScD,

    1. From the Department of Emergency Medicine (JCP, GKH, PMH, MLM), the Department of Anesthesia and Critical Care Medicine (JCP, PJP), and the Department of Surgery (JCP, PJP), Johns Hopkins University School of Medicine, Baltimore, MD.
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  • Peter J. Pronovost MD, PhD

    1. From the Department of Emergency Medicine (JCP, GKH, PMH, MLM), the Department of Anesthesia and Critical Care Medicine (JCP, PJP), and the Department of Surgery (JCP, PJP), Johns Hopkins University School of Medicine, Baltimore, MD.
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Address for correspondence and reprints: Julius Cuong Pham, MD; e-mail: jpham3@jhmi.edu.

Abstract

Objectives:  The objective was to estimate the national left-without-being-seen (LWBS) rate and to identify patient, visit, and institutional characteristics that predict LWBS.

Methods:  This was a retrospective cross-sectional analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1998 to 2006. Bivariate and multivariate analyses were performed to identify predictors of LWBS.

Results:  The national LWBS rate was 1.7 (95% confidence interval [CI] = 1.6 to 1.9) patients per 100 emergency department (ED) visits each year. In multivariate analysis, patients at extremes of age (<18 years, odds ratio [OR] = 0.80, 95% CI = 0.66 to 0.96; and ≥65 years, OR = 0.46, 95% CI = 0.32 to 0.64) and nursing home residents (OR = 0.29, 95% CI = 0.08 to 1.00) were associated with lower LWBS rates. Nonwhites (black or African American (OR = 1.41, 95% CI = 1.22 to 1.63) and Hispanic (OR = 1.25, 95% CI = 1.04 to 1.49), Medicaid (OR = 1.47, 95% CI = 1.27 to 1.70), self-pay (OR = 1.96, 95% CI = 1.65 to 2.32), or other insurance (OR = 2.09, 95% CI = 1.74 to 2.52) patients were more likely to LWBS. Visit characteristics associated with LWBS included visits for musculoskeletal (OR = 0.70, 95% CI = 0.57 to 0.85), injury/poisoning/adverse event (OR = 0.65, 95% CI = 0.53 to 0.80), and miscellaneous (OR = 1.56, 95% CI = 1.19 to 2.05) complaints. Visits with low triage acuity were more likely to LWBS (OR = 3.59, 95% CI = 2.81 to 4.58), whereas visits that were work-related were less likely to LWBS (OR = 0.19, 95% CI = 0.12 to 0.29). Institutional characteristics associated with LWBS were visits in metropolitan areas (OR = 2.11, 95% CI = 1.66 to 2.70) and teaching institutions (OR = 1.33, 95% CI = 1.06 to 1.67).

Conclusions:  Several patient, visit, and hospital characteristics are independently associated with LWBS. Prediction and benchmarking of LWBS rates should adjust for these factors.

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