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Did Not Wait Patients: Low-Risk for Admission and Deterioration
Daniel Stewart1, Miles Greenberg2,3, Simon Heppell1
1Department of Emergency Medicine, Dubbo Health Service, Dubbo, Australia.
Emergency Medicine Australasia : EMA
|September 4, 2025
Summary
Most patients who did not wait (DNW) for emergency department care did not experience clinical deterioration or require hospital admission related to their initial visit. These findings suggest a need to re-evaluate performance metrics focused on DNW episodes.
Area of Science:
- Emergency Medicine
- Health Services Research
- Patient Safety
Background:
- 'Did not wait' (DNW) encounters in emergency departments (EDs) are often assumed to indicate high patient risk.
- Limited data exists on the clinical outcomes and subsequent hospital admissions for patients who leave EDs without being seen.
Purpose of the Study:
- To quantify the proportion of hospital admissions following a DNW encounter that are linked to the initial care episode.
- To assess the frequency of clinical deterioration in patients who DNW and subsequently re-present.
Main Methods:
- Retrospective observational study at Dubbo Health Service, Australia.
- Analysis of patient-level data from May to October 2023.
- Inclusion of patients with a DNW episode who re-presented to the ED and were admitted within 28 days; clinical record review to determine admission relatedness and deterioration.
Main Results:
- Out of 14,247 ED presentations, 7.4% (1123) were DNW.
- 315 patients re-presented within 28 days, with 32 admissions.
- 26 admissions were related to the DNW episode; 5 (0.4% of DNW cohort) showed clinical deterioration.
Conclusions:
- The majority of DNW episodes do not lead to clinical deterioration or related hospital admissions.
- Findings challenge the assumption of high risk associated with DNW patients.
- Health systems may need to reassess performance metrics and resource allocation for DNW episodes.
Keywords:
did not waitincomplete emergency department attendanceskey performance indicatorpatient safetyquality improvementMore Related Videos
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