Patients who leave the emergency department without being seen face higher risk of death, hospitalization

Toronto, ON, December 18, 2024 – Since 2020, more Ontario adults are leaving the emergency department without being seen and they face a 14% higher risk of death or hospitalization within seven days, according to a new study from ICES.

The researchers also found that the increased risk of death or hospitalization persisted through to 30 days after the emergency department (ED) visit, though the risk fell to 5%. This finding comes despite fewer monthly ED visits since 2020 compared to the pre-pandemic period (2014-2020). 

“There are many reasons why people choose to leave the emergency department, but it’s usually about wait times,” says lead author Dr. Candace McNaughton, an emergency medicine physician and scientist at ICES and Sunnybrook Health Sciences Centre.  

“There’s an assumption made that if people leave the ED before being seen, they’re well enough to go and they will probably be fine. But our findings paint a different picture,” she says. 

Leaving Without Being Seen (LWBS) Rates Higher Post-Pandemic 

All ED visits for adults living in Ontario, Canada were identified from 2014 to 2023. The researchers assessed trends in ED visits and compared a more recent time period (April 1, 2022 to March 31, 2023) to a pre-pandemic baseline period (April 1, 2014 to March 31, 2020). For this comparison, only the first LWBS ED visit was assessed, as repeated visits may have signaled differences in an individual’s health risk or patterns in health care use. 

Key findings include: 

• Rates of monthly total and LWBS ED visits for adults were higher and remained elevated longer in Ontario EDs, exceeding the single-month pre-pandemic peak LWBS ED visit rate of 4% during 15 out of 36 months between 2020 and 2023 (42% of the time) and 9 out of 12 months (75% of the time) during the most recent period of 2022 and 2023. 

• Patients with a LWBS ED visits during 2022-2023 had a 14% higher risk of death or hospitalization within 7 days, despite similar post-ED follow-up (i.e. a visit to a family doctor or other healthcare visit). 

• Patients in the 2022-2023 LWBS group had a median age of 41 years, and 74% had no history of hospitalization in the prior five years. 

• A follow-up analysis that looked at all-cause mortality found a 46% higher risk of death at 7 days and 24% higher risk at 30 days. 

• There was no evidence to show that patients were seeking emergency care for minor issues or as an alternative to outpatient care. 

“What’s striking about these findings is that people leaving the ED are younger and have no history of hospitalization,” says Dr. McNaughton. “Another red flag is that many made contact with primary care and still had a higher risk of dying.” 

The authors caution that these events should not be considered benign, especially in the context of rising rates of ED visits, on-going closures of EDs (particularly in rural areas), inadequate long-term care beds, nurses and physician shortages, and worsening access to primary care. 

“Taken together, our findings suggest that people seeking emergency care may now be at greater risk for poor outcomes than in the past. Our universal health care system urgently needs significant investment of resources to support both emergency and primary care, in order to meet the health care needs of our growing, aging, and increasingly medically complex population.” 

The article “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” was published in the Journal of the American College of Emergency Physicians. 

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario 

FOR FURTHER INFORMATION PLEASE CONTACT:  

Misty Pratt 
Senior Communications Associate, ICES 
[email protected] 343-961-6982