Mortality and Return Visit Frequency Among Emergency Department Patients Who Leave Without Being Seen at a Regional Health Care System

Abstract

Background

The rate of emergency department (ED) patients who leave without being seen (LWBS) is a commonly reported quality metric that increased across the United States in concert with COVID-19. However, it is unclear what proportion of patients leave despite an acute medical need. The authors sought to estimate the rates at which patients who leave return, including hospitalization, relative to patients who are evaluated and discharged.

Methods

This was a retrospective cohort study examining adult patients presenting between January 1, 2019, and January 1, 2023, across an integrated system including 10 EDs. Demographic variables were compared using independent chi-square tests. Clinical outcomes, including rates of return visits at 72 hours and 30 days (including inpatient admission or ICU admission), and 30-day mortality were compared using multivariate logistic regression.

Results

A total of 1,474,395 visits were included, of which 17,523 (1.2%) were LWBS. Patients in the LWBS group were younger (48.1 years [95% confidence interval (CI) 48.1–48.2] vs. 44.8 years [95% CI 44.6–45.1], p < 0.001), more likely to be of Hispanic ethnicity (177,895 [17.7%] vs. 3,884 [22.2%], p < 0.001), and more likely to require a translator (131,510 [13.1%] vs. 3,184 [18.2%], p < 0.001). Independent of other clinical and demographic variables, LWBS was associated with more frequent returns within 72 hours (adjusted odds ratio [AOR] 2.56, 95% CI 2.50–2.62, p < 0.001), 30-day ICU admission (AOR 1.35, 95% CI 1.27–1.66, p < 0.001), and mortality within 30 days (AOR 2.59, 95% CI 1.90–3.53, p <0.001).

Conclusion

Patients who left without being seen were more likely to return, to require admission, and to die within 30 days than those discharged. High LWBS rates, most pronounced among disadvantaged groups, should be considered as a source of harm to patients.