Emergency department volume and acuity as factors in patients leaving without treatment

Patients who leave emergency departments (EDs) without treatment represent potential personal and hospital liability. Many department-dependent factors have been linked to patients who leave without treatment (LWT) in high-volume EDs. The authors studied how department volume and acuity influence LWTs in a small, low-volume, university-affiliated ED.

Through retrospective ED census review, LWTs, department volume, and department acuity were recorded for 12-hour shifts over 1 year. Department acuity is defined as patients requiring resuscitation or admission.

Over a 12-month period, 629 of 18,664 patients left the ED. When shift volume exceeded 25 patients, there were significantly more LWTs. When department acuity exceeded four patients per shift, there were also significantly greater numbers of LWTs. More than half of all shifts exceeded one of these thresholds.

Thresholds of 25 patients and an acuity of five patients per shift were associated with significant increases in LWTs, suggesting possible per-physician maximum patient loads before an increased risk of LWT patients.