Missed Opportunity: Patients Who Leave Emergency Departments without Being Seen

A small but important fraction of patients who go to emergency departments (EDs) never get care because they leave before being evaluated and treated. The rate at which this occurs is an indicator of ED performance (US General Accounting Office 2003). In the United States in 2001–2002, between 1.4% and 1.9% of patients left EDs without being seen (McCaig and Burt 2004; US General Accounting Office 2003). In Australia, the rate in 2003–2004 was reported to be higher (5.2%; Australian Institute of Health and Welfare 2005). In Canada, published estimates based on single-facility studies are 1.4% (Fernandes et al. 1994) and 3.6% (Monzon et al. 2005). Internationally, studies of factors associated with patients leaving EDs before being seen have focused on patient- and hospital-related issues. For example, acute psychological distress at the time of visit (Weissberg et al. 1986), pressing commitments elsewhere (Fernandes et al. 1994), perceived poor communication with staff (Fernandes et al. 1994; Arendt et al. 2003) and low acuity with spontaneous resolution of symptoms while waiting (Goldman et al. 2005) are some of the patient-related factors that have been documented to date. A hospital-related factor identified in many studies is prolonged waiting time to see a physician (Fernandes et al. 1994; US General Accounting Office 2003; Kyriacou et al. 1999). This study investigates how often patients leave Ontario EDs without being seen (LWBS) and considers both patient- and facility-level factors that may be associated with increased risk for LWBS.