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Factors Associated With Leaving-Without-Being-Seen in Pediatric Emergency Department Patients

Takashi Nihira1,2, Takateru Ihara1,3, Yuta Sasaoka1,4

  • 1Department of Pediatric Emergency Care and Intensive Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN.

Cureus
|January 7, 2025
PubMed

Insights

Preventing children from leaving without being seen (LWBS) is vital. Low acuity, longer wait times, and weekend/evening visits significantly increase LWBS risk in pediatric emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Management
  • Patient Safety

Background:

  • Leaving without being seen (LWBS) in pediatric emergency care poses risks due to children's limited autonomy in seeking healthcare.
  • Limited data exists on LWBS prevalence and contributing factors in Japan, necessitating research to understand its impact on healthcare.
  • This study addresses the gap by examining LWBS in a Japanese pediatric tertiary care setting.

Purpose of the Study:

  • To investigate the incidence of leaving without being seen (LWBS) among pediatric patients after triage.
  • To identify key factors associated with LWBS in a Japanese pediatric emergency department.
  • To provide data for improving patient safety and resource allocation in pediatric emergency care.

Main Methods:

  • A retrospective cohort study design was employed.
  • Data was extracted from an electronic administrative database of a tertiary pediatric medical center in Japan.
  • Records of children aged 15 years or younger presenting between April 2014 and March 2017 were analyzed for LWBS and associated factors.

Main Results:

  • A total of 112,059 pediatric patients were included, with 168 (0.15%) identified as LWBS.
  • Factors significantly associated with LWBS included lower triage acuity (OR: 2.33), weekend/holiday visits (OR: 1.71), and evening visits (OR: 1.44).
  • Extended emergency department length of stay (EDLOS > 1 hour, OR: 3.48) and waiting times (> 1 hour, OR: 41.93) were strongly linked to increased LWBS.

Conclusions:

  • Low patient acuity, non-urgent visit times (evenings, weekends/holidays), prolonged EDLOS, and extended waiting times are significant predictors of LWBS in pediatric emergency care.
  • These findings align with international research, suggesting the generalizability of factors contributing to LWBS.
  • Interventions targeting wait times and resource management during peak hours may reduce pediatric LWBS rates.

Keywords:
acuityemergency servicesleaving-without-being-seentriagewaiting time

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