Abstract

LUGO, Silvina  and  PAVLICICH, Viviana. Abandonment of the Emergency Department by Untreated Patients. Pediatr. (Asunción) [online]. 2011, vol.38, n.1, pp.17-22. ISSN 1683-9803.

ABSTRACT Introduction: It is important to understand the factors associated with early withdrawal of patients from the Emergency Department. Triage classification by risk level is also vital. Objective: To determine the factors involved in patients abandoning the emergency department before completing the process of care. Material and Methods: a retrospective, descriptive and analytical study. Patients who withdrew at some point in the care process from the emergency room of Niños de Acosta Ñu General Pediatric Hospital between January 1 and July 31, 2010. Results: The hospital attends an annual average of 45,000 patients. During the study period, a total of 31,823 patients presented at the hospital. Of those, 1131 (3.55%) withdrew without being seen. Of those, 210 left prior to triage and 728 left after triage but before medical assessment. Of those seen by a doctor, 193 withdrew without being re-assessed 113 were sent for lab tests but did not return, 75 withdrew without clinical reassessment, and 5 against medical advice; all were seen within the period of time allotted according to risk classification. 938 children left the hospital without being seen by a medical professional. Mean Age: 4.7 years. In the months of January and February a higher percentage (4.26%) of premature withdrawal was noted, while the mean number of patients seen per month was 4546. A significant relationship was found between living within 5 km and withdrawal before triage (SD: -5). Mondays saw the most withdrawals, 246 patients (4.48% of all 31,000 patients for the period) withdraw without completing treatment, while Sundays was the day of the week with fewest early withdrawals (2%). The arrival time most associated with risk of withdrawal was between noon and 01:00PM (p=0.0023). In pre-triage waiting time before triage was 27.5 minutes on average. Waiting time for medical attention averaged 107.46 minutes including 61.4 minutes for urgent cases (3.2% of patients), 109.6 minutes for semi-urgent cases (91.7% of patients) and 95 minutes for non-urgent cases (5% of patients). A significant difference was seen in waiting times according to assigned risk classification. (p: 0,0004). No patients classified as "emergency" withdrew without being seen. Conclusions: Predictors of early patient withdrawal in our series included living near the hospital, longer waiting times, the day being Monday, due to a greater flow of patients, while the noon hour was also significantly seen as a factor related to withdrawal before being seen. Most were schoolchildren classified as semi-urgent or non-urgent.

Keywords : emergency department; utilization; emergency medicine; public health; patient care; triage; treatment refusal; non-compliance; patient satisfaction.

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