Emergency department patients who leave without seeing a physician: the Toronto Hospital experience

To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care.

A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demographics, presenting complaints, and clinical acuity rating. Follow-up was achieved within 6 weeks through mailed survey questionnaires and telephone interviews.

Two inner-city EDs of the Toronto Hospital, a quaternary care facility.

All 423 patients who registered for care and left without being seen during a 16-week period from January to May 1991.

Of 23,933 registered patients, 423 (1.4%) left without being seen. Follow-up was achieved on 39% of patients (165 of 423). Sixty-seven percent of those who left (284 of 423) had low acuity ratings. Of the 165 survey respondents, 107 (65%) left between 30 minutes and 2 hours after registration. The major reasons cited for leaving included prolonged waiting time (99 of 165, 60%), perceived difficulties with hospital staff (46 of 165, 28%), and pressing commitments elsewhere (45 of 165, 27%). Ninety-two percent (152 of 165) believed they should be evaluated by a physician within 1 hour of presentation. Forty-eight percent (80 of 165) sought further medical attention within 24 hours. Personal physicians (65 of 165, 39%) and other EDs (29 of 165, 18%) were the most common sources of further medical care.

The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these patients sought alternate medical care through their personal physician or other EDs.