Emergency Department Volume and Patient Acuity as Factors in Patients Leaving without Treatment

• Published in: Academic emergency medicine 2003-05, Vol.10 (5), p.528-528
• Main Author: McMullan, J. T
• Format: Article
• Language: English
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.528

OBJECTIVES: Any patient that leaves the emergency department (ED) without being seen by a physician represents a liability to himself and the hospital. Waiting room time, ED volume, and total hospital admissions through the ED have been linked to patients who leave without treatment (LWT); these studies, however, were done at large trauma centers with annual ED censuses above 75,000 and staffed by several physicians. This study investigates if volume and acuity influence the rate of patients leaving without treatment from a community hospital emergency department with an annual census of less than 20,000 and staffed by a single attending physician. METHODS: Using a retrospective ED census review, patient volume, numbers of admissions, and LWTs were recorded for 12-hour intervals over a one-year period. Patient acuity is defined as the number of patients requiring ED resuscitation efforts and/or admission to the hospital. Patient-specific information (demographics, chief complaint, etc.) was not collected. RESULTS: Over a twelve-month period, 629 of 18,664 patients absconded from the emergency department (3.4%). Median volume was 23 patients per 12-hour shift; median acuity was 3 patients per shift. When total volume exceeded 25 patients per shift, there were significantly more LWTs than at low patient volumes (0.68 vs. 0.28 per shift, p