EMERGENCY DEPARTMENT PATIENTS WHO LEAVE WITHOUT SEEING A PHYSICIAN - THE TORONTO HOSPITAL EXPERIENCE

Study objectives: To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care. Design: A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demo graphics, presenting complaints, and clinical acuity rating. Follow-up was achieved within 6 weeks through mailed survey questionnaires and telephone interviews. Setting: Two inner-city EDs of the Toronto Hospi tal, a quaternary care facility. Participants: All 423 patients who re gistered for care and left without being seen during a 16-week period from January to May 1991. Results: Of 23,933 registered patients, 423 (1.4%) left without being seen. Follow-up was achieved on 39% of patie nts (165 of 423). Sixty-seven percent of those who left (284 of 423) h ad low acuity ratings. Of the 165 survey respondents, 107 (65%) left b etween 30 minutes and 2 hours after registration. The major reasons ci ted for leaving included prolonged waiting time (99 of 165, 60%), perc eived difficulties with hospital staff (46 of 165, 28%), and pressing commitments elsewhere (45 of 165, 27%). Ninety-two percent (152 of 165 ) believed they should be evaluated by a physician within 1 hour of pr esentation. Forty-eight percent (80 of 165) sought further medical att ention within 24 hours. Personal physicians (65 of 165, 39%) and other EDs (29 of 165, 18%) were the most common sources of further medical care. Conclusion: The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these pati ents sought alternate medical care through their personal physician or other EDs.