Emergency Departments (ED) patients who left without being seen (Did Not Wait)

Abstract

Background: Since the COVID-19 pandemic there has been an increase in the number of patients seeking care in Emergency Departments (EDs) who leave without being seen (DNW). Internationally the DNW rate ranges from 1 to 15%. The average rate in Victoria pre-pandemic was 5-6% In September 2022, NSW reported that one in 10 patients left the ED before receiving treatment prompting the then ACEM president to call this a “major safety risk”. At our institution the DNW rate peaked at 15% during the second wave of COVID-19. As of March 2024, it remains high at 9%. Methods: This project uses a mixed methods research methodology (retrospective audit of medical records with nested questionnaire auto-invitation using REDcap and Message Media®). Patients are recruited over 3 blocks of 2 months, about 550 patients per block to capture seasonal variation. Study months are April/May, July/August, October/November Results: Interim results from first two cycles of data with a third cycle remaining resulted 1,111 participant whose records were analysed and were invited to participate in the survey of which 235 (21%) responded. Participant of observational versus (survey) demographics were mean age 38 years (43 years), gender 53% (68%) were female. Highest number of Australian Triage Category allocations were 4 with n=462 (3, n=100) with p=0.760, mode of arrival was private 84% (89%) with p=0.388, ED length of stay was 203 minutes (208 minutes) with p=0.764 and 93% (94%) reported having a general practitioner, p=0.605. On future visits to ED among survey respondents, 63% reported will be utilising ED as usual or even more and 37% reported will be using ED services less. Follow-up care was sought by 72% of the respondents. Conclusions: This study showed that patients who DNW did so during times of high activity, had a prolonged wait of over 3 hours, and presented with higher acuity than previously documented (~50% ATS 2 and 3). Most patients (72%) required follow up care. High levels of DNW are likely to lead to adverse patient outcomes.