Patients regularly leave emergency departments before medical assessment: A study of did not wait patients, medical profile and outcome characteristics

In 2001 New South Wales Health reported an increase in the number of patients who did not wait for treatment in emergency departments. Because so little was known about this group of patients a study was conducted to indentify: (1) the characteristics and reasons for patients leaving prior to medical assessment; (2) patients' illnesses or conditions, urgency code and nature of ED encounter; and (3) DNW patient outcomes. A 13 question telephone survey was conducted which focused on the presenting complaint, waiting times, staff communication and patient outcomes.

During the three-month study, 64% of eligible patients were contacted. The reasons they gave for leaving were largely because of the time delay in being seen, but some left because their condition resolved or they felt too ill to stay or they received treatment or reassurance from the triage nurse. A small number of patients left because of safety concerns in the waiting room, because they had other commitments or because staff were rude. Some patients left to go to other facilities; almost 70% of patients sought medical attention within 24 hours of leaving the ED.

The endemic problem of overcrowding is placing demands on EDs to review and reform service delivery. While the study was conducted in a tertiary referral centre this ED is characteristic of most others across Australia. Outcome analysis of this vulnerable group is required.