Many who leave emergency rooms without been seen return within a week
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Key takeaways:
- Nearly one-fifth of individuals who leave the ED without being seen returned in the next 7 days.
- Patients usually returned at a similar time of day, indicating they may have trouble accessing nonemergent care.
About one in five individuals who leave the ED without being seen return in the next week, usually around the same time of day, according to the results of cohort study.
A secondary analysis also revealed that more than one-quarter of those who left the ED without been seen returned with 30 days, according to researchers.
Emergency services, especially EDs, face mounting difficulties like overcrowding with a reduced hospital capacity, longer wait times and rising numbers of patients who leave without being seen, Christopher S. Evans, MD, MPH, associate chief medical informatics officer at East Carolina University Health, and colleagues wrote in a research letter published in JAMA.
“Understanding the patient characteristics associated with [leaving without being seen] and the downstream consequences, such as care delays and subsequent repeat visits, may assist health care systems with improving systemic flow processes to optimally care for patients and ensure their safety,” they wrote.
The researchers conducted a retrospective cohort study using 2023 data from Epic Cosmos, which includes information about more than 270 million patients at more than 1,500 hospitals nationwide.
Over a year-long study period, researchers reported 316,321 patients who left without being seen and 345,938 visits (just 1.1% of all ED visits in the data). Of the patients who left without being seen (mean age, 43.7 ± 17.3 years; 55.7% women; 53% white), 13.2% arrived via an emergency medical service and 55.2% had private insurance. The study cohort included individuals from all 50 states, but the highest percentages came from New York (7.94%), Ohio, Pennsylvania and Florida.
An estimated 18.5% of patients who left without being seen returned to the ED at least once in the next 7 days. About 0.19% were admitted to the ICU, and 1.63% were admitted to the hospital. Researchers reported a median time interval from leaving to returning of 46.6 hours, and just over half (58.3%) returned to the same place they initially left.
They also found in a secondary analysis that 28.4% of patients who left without being seen had at least one return visit in the following 30 days.
“Return ED visits in this study had a decaying oscillating pattern at intervals of 24 hours, suggesting patients return to the ED at a similar time of day and may have difficulty accessing care in non-ED environments aligning with their availability or preferences,” Evans and colleagues wrote. “Ongoing efforts to reduce return ED utilization among patients [who left without being seen] may benefit from alternative care options that meet patient needs, including outside traditional business hours.”
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