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Children who leave the emergency department without being seen: a retrospective case note review
Nicola Sparrow1, Trudie Pestell1, Mike Clancy1
1Emergency Department, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
Insights
Many children leave the emergency department without being seen (LWBS), but few require hospital admission after reattending. Tracking reattendance is more informative than just the LWBS rate.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
Background:
- Children leaving emergency departments without being seen (LWBS) represent a vulnerable population at risk of harm.
- Timely and accessible emergency services are crucial for pediatric patient safety.
Purpose of the Study:
- To determine the incidence of pediatric patients leaving the emergency department without being seen (LWBS).
- To investigate the outcomes of these children within 7 days of their initial attendance.
- To assess the relevance of the College of Emergency Medicine's LWBS Quality Indicator (QI 4).
Main Methods:
- A 6-month retrospective review of pediatric emergency department attendances.
- Analysis of all cases where patients left without being seen (LWBS).
- Tracking of reattendance and admission status within 7 days.
Main Results:
- Out of 10,795 pediatric attendances, 544 (5%) left without being seen (LWBS).
- 12.6% of LWBS patients (69/544) reattended within 7 days.
- Only 1.3% (7/544) of LWBS patients required admission for over 12 hours.
Conclusions:
- Most pediatric patients leave the emergency department without being seen (LWBS) during peak hours.
- The rate of reattendance and subsequent case note review provides more valuable insight than the LWBS rate alone.
- A small proportion of children who leave without being seen require significant medical intervention upon reattendance.
Introduction:
Children who attend an emergency department and then leave without being seen (LWBS) are a major concern as they are a potentially vulnerable group who may come to harm through failure to provide a timely and accessible service.
Objectives:
We wished to establish the size of this population and importantly what subsequently happened to them over the following 7 days from their initial attendance, and the relevance of the College of Emergency Medicine LWBS Quality Indicator (QI 4) to this group.
Methods:
A retrospective case note review over 6 months of all paediatric attendances who LWBS.
Setting:
Southampton Paediatric Emergency Department.
Results:
During a 6-month study period, 10 795 attended, of which 544 (5%) LWBS. 12.6% (69/544) reattended over the next 7 days, of which 14 were admitted, 7 for <12 h.
Conclusions:
The majority who LWBS do so during peak times. Very few paediatric patients who LWBS then reattended required admission for >12 h (7/544, 1.3%). The rate of reattendance of those who LWBS and review of their case notes is potentially more valuable than the LWBS rate alone.
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