Patients Who Leave the Emergency Department Before Treatment Completion: A Retrospective Cohort Study

Patients leaving the emergency department (ED) before treatment completion (LBTC) is a common universal occurrence. We hypothesized that the characteristics of the Israeli health care system, as well as its policy, intended to reduce the burden of nonurgent ED visits, may have an impact on factors associated with LBTC.

The purpose of this study was to explore factors associated with LBTC in the Israeli context.

This was a retrospective cohort study of patients who visited the ED in a major hospital located in northern-central Israel during 2016-2019. Characteristics of 130 randomly sampled LBTC patients and of 130 non-LBTC patients that constituted the control group, were compared. Odds ratios (OR) are presented.

A low-acuity triage score (OR 8.18, p < 0.01) and a longer length of stay (OR 1.15, p < 0.01) were found to be risk factors for LBTC, and female gender (OR 0.40, p < 0.01) was found to be a protective factor. In contrast, age and nationality were not found as risk factors. Significant differences were found between the two groups with regard to the main presenting complaint. However, both groups had similar rates of presentations with a psychiatric condition. Approximately half of the LBTC patients presented at times when primary clinics were active.

These findings reflect the strengths of the Israeli health care system. Despite the policy intended to reduce the burden of nonurgent ED visits, there are possible shortcomings in the system that should be addressed.