Hospital factors associated with emergency center patients leaving withoutbeing seen

We developed a statistical model that would identify and quantify the relat ive contributions of different factors hypothesized to impact the frequency of emergency center (EC) patients who leave without being seen (LWBS), We performed an analysis of the daily counts of patients that registered in ou r EC during a 21-month period who then LWBS, Candidate predictor variables included the number of patients seen, and the number admitted to the hospit al, for each area of our EC, as well as the hours of faculty double coverag e, and the day of the week, Univariate analyses were performed using standa rd methods. Multivariate analysis was performed using the general linear mo del. A backward selection procedure was used to eliminate statistically ins ignificant variables until all remaining independent variables had P-values less than or equal to .05, External validation and analysis of the stabili ty of the estimated regression coefficients of the model were evaluated usi ng bootstrap methods, Two tailed tests and a type I error of 0.05 were used . During the period studied, 133,666 patients were registered in the EC and 9,894 (7.4%) left, Multivariate analysis identified six variables that wer e significantly associated with LWBS, The fitted model containing all six v ariables explained 52.8% of the variability observed in LWBS frequency, The most powerful predictor of LWBS was total number of patients cared for in the main ED, This accounted for 46.4% of the observed variation in LWBS, Th e total number of trauma and resuscitation patients, and the total number o f observation unit admissions to the hospital were also associated with inc reased LWBS, More pediatric cases seen in the main ED, weekends, and additi onal faculty coverage were associated with fewer patients leaving. Efforts to decrease the LWBS rate will be most successful if they address the issue of main ED volume. Copyright (C) 2000 by W.B. Saunders Company.