Leaving the emergency department without being seen more likely at hospitals that serve more low-income patients
As strains on the emergency care system have mounted, the proportion of patients who leave the emergency department (ED) without being seen has increased dramatically. Many ED patients who leave without being seen (LWBS) are seriously ill, require immediate evaluation, and are at risk of poorer outcomes. A new study reveals that EDs serving low-income communities and communities with a high proportion of poorly insured patients had higher LWBS rates. Overall, the LWBS rate among 262 California hospitals studied varied from 0 percent to 20.3 percent.
Patients who leave the ED without being seen represent the failure of an emergency care delivery system to meet its goals of providing care to those most in need, suggest the California researchers. They looked at the relationship between the rates of LWBS in 9.2 million ED visits at 262 California hospitals in 2007 and hospital-level socioeconomic case mix and other hospital characteristics. Hospital structural characteristics associated with increased LWBS included county ownership, trauma center designation, and teaching program affiliation.
The researchers concluded that EDs seeking to decrease their LWBS rate will likely need to institute changes that go beyond fine-tuning ED operations. The study was supported in part by the Agency for Healthcare Research and Quality (HS18098).
See "Hospital determinants of emergency department left without being seen rates," by Renee Y. Hsia, M.D., Steven M. Asch, M.D., Robert E. Weiss, Ph.D., and others in the July 2011 Annals of Emergency Medicine 58(1), pp. 24-32.
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