PEDIATRIC EMERGENCY DEPARTMENT WALK-OUTS

The objectives of this study were to determine reasons for leaving a p ediatric emergency department before physician evaluation, any adverse outcomes of those leaving, and to assess whether the presence of an o mbudsman altered the pattern. This was a prospective follow-up study o f all patients who left the pediatric emergency department of the Chil dren's Hospital of Michigan before physician evaluation between Octobe r 24, 1991 and January 30, 1992. Information was obtained from medical records and a telephone questionnaire with the parent or guardian one week later. A control group of patients (n = 150) evaluated in the sa me period were randomly selected for comparison and matched for triage acuity score, shift, and weekday/weekend visit. Five hundred and twel ve patients left during this period. Contact was made with 82% (419). Forty-three percent of patients left only because of a long wait, and an additional 19% included a long wait as one of the reasons for leavi ng. There was a significantly longer waiting time for walk-outs compar ed with controls (188 +/- 76.4 vs 93.6 +/- 64.9 minutes, P < 0.0001). Of the 419 patients followed, 256 (61%) were seen by a physician withi n seven days, and seven (1.7%) were hospitalized. Three hundred one (7 2%) were reported to be well; 108 (26%) were better. No deaths occurre d. Hospitalization rates were significantly lower for patients who lef t compared with patients who stayed over the same period of time (7/41 9 vs 1931/16,990, P < 0.0001). The presence of an ombudsman was associ ated with an increase in walk-outs. We concluded that patients leaving before physician evaluation had longer waiting times than those who s tayed. One week later 98% were either well or better. The presence of an ombudsman, intended to be a patient advocate, resulted in more pati ents leaving before being seen.