Characteristics and Outcomes of Emergency Department Patients Who Did Not Wait for Treatment: A State-Wide Data...

Describe the characteristics and predictors of emergency department (ED) patients who 'did not wait' (DNW).

Data linkage study using routinely collected public hospital data in New South Wales, Australia. Cases were included if an initial ED episode of care occurred between January 2021 and December 2022 with an ED mode of separation of DNW. The main outcome was representation to an ED within 7 days of the initial DNW episode of care, and the secondary outcome was 30-day mortality from the initial DNW date. Frequent presenters were those with ≥ 10 ED episodes of care within 365 days. Predictors for representation were determined using logistic regression, presented as odds ratio [95% confidence interval].

The 7-day representation rate after a DNW episode was 14.8% (n = 29,030). Of those, 23.1% presented to a different hospital. 30-day mortality was significantly higher in those who were represented within 7 days versus those who did not represent within 7 days (0.4% vs. 0.1%, p < 0.001). The main predictors of representation within 7 days were: frequent presenters (4.35 [4.13-4.58], p < 0.001), increasing age, with those aged > 85 years having the highest odds of representation (1.71 [1.58-1.86], p < 0.001) and initial presentation during the evening (6:00 PM-11:59 PM; 1.49 [1.44-1.53], p < 0.001).

14.8% of patients who do not wait for care in an ED are represented within 7 days, approximately one quarter presenting to a different facility. Identifying predictors for those patients associated with DNW presentations provides evidence around patient safety and quality of care issues.