{"id":20834,"date":"2024-12-18T14:41:04","date_gmt":"2024-12-18T19:41:04","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=20834"},"modified":"2024-12-19T10:23:11","modified_gmt":"2024-12-19T15:23:11","slug":"higher-rates-of-left-without-being-seen-emergency-department-visits-and-associations-with-increased-risks-of-adverse-patient-outcomes-since-2020","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/higher-rates-of-left-without-being-seen-emergency-department-visits-and-associations-with-increased-risks-of-adverse-patient-outcomes-since-2020\/","title":{"rendered":"Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020"},"content":{"rendered":"<p><strong>Objective<\/strong>\u00a0\u2014\u00a0To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen ED (LWBS ED) visit since 2020.<\/p>\n<p><strong>Methods <\/strong>\u2014 In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014-2023. In patient-level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7-day all-cause mortality or hospitalization following a LWBS ED visit for April 1, 2022-March 31, 2023 (recent period) to April 1, 2014-March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index.<\/p>\n<p><strong>Results<\/strong>\u00a0\u2014\u00a0Despite fewer monthly ED visits since 2020, temporal trends revealed sustained increases in monthly LWBS rates. LWBS ED visits after April 1, 2020 exceeded the baseline period\u2019s single-month LWBS maximum of 4.0% in 15 out of 36 months. The composite outcome of 7-day all-cause mortality or hospitalization was 3.4% in the recent period vs. 2.9% in the baseline period (adjusted risk ratio (aRR) 1.14 , 95% CI 1.11-1.18) and remained elevated at 30 days (6.2% versus 5.8%, respectively; aRR 1.05, 95% CI 1.03-1.07), despite similar rates of post-ED outpatient visits (7-day recent and baseline: 38.9% and 39.7%, respectively, p=0.38; 30-day: 59.4% and 59.7%, respectively, p=0.05).<\/p>\n<p><strong>Conclusions<\/strong>\u00a0\u2014\u00a0The rate of short-term mortality or hospitalization after a LWBS ED visit has recently increased, despite fewer ED visits\/month and similar proportion of post-ED outpatient encounters. This concerning signal should prompt interventions to address system- and population-level causes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objective\u00a0\u2014\u00a0To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen ED (LWBS ED) visit since 2020. Methods \u2014 In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014-2023. In patient-level analyses restricted to the first eligible LWBS [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[24,62],"migration-helper-qa-sample-set":[],"class_list":["post-20834","journal_article","type-journal_article","status-publish","hentry","topic-acute-and-emergency-services","topic-health-services-research"],"acf":{"citation":"<span lang=\"EN-US\">McNaughton CD, Austin PC, Chu A, Santiago-Jimenez M, Li E, Holodinsky JK, Kamal NR, Kumar M, Atzema CL, Vyas MV, Kapral MK, Yu AYX. <em>JACEP<\/em>. 2024; Dec 13.<\/span>","source_url":"https:\/\/doi.org\/10.1002\/emp2.13299","ices_scientist":[19849,1385,1383,1118,1150,1298],"site":[6733],"research_program":[6742],"news_release":[20845],"journal_article":"","atlas":"","research_report":"","infographic":[20848],"video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020<\/title>\n<meta name=\"description\" content=\"Objective\u00a0\u2014\u00a0To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen ED (LWBS ED) visit since 2020. 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