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
Objective — To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen ED (LWBS ED) visit since 2020.
Methods — 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.
Results — Despite 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’s 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).
Conclusions — The 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.
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Citation
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. JACEP. 2024; Dec 13.