Emergency Care Patient Walk-Outs Surge 53% During COVID

TOPLINE:

A cross-sectional analysis of 721 million emergency department (ED) visits reveals that approximately 6 million patients left before medical attention (BMA). BMA rates were elevated among men, those with substance use disorders, and those with public insurance, with a sharp increase during the COVID-19 pandemic.

METHODOLOGY:

• Researchers conducted a pooled, cross-sectional analysis of 721 million ED visits using the National Hospital Ambulatory Medical Care Survey from 2016 to 2021.
• The main outcome was the proportion of patients who left BMA during an ED visit.
• Researchers also evaluated the factors associated with leaving BMA.
• About one third (30.2%) of all visits were due to injury, trauma, or overdose; 11.7% of visits led to a hospital admission, and 16.7% of visits involved arrival via an ambulance.

TAKEAWAY:

• In total, 5.9 million (0.8%) ED visits resulted in patients leaving BMA.
• The predictors of increased BMA odds included alcohol or substance use disorders (adjusted odds ratio [aOR], 2.19), public insurance (aOR, 1.86), arrival by an ambulance (aOR, 1.68), and male sex (aOR, 1.32).
• Hospital admissions and trauma-related visits were linked to decreased BMA odds (aOR, 0.11 and 0.54, respectively).
• The COVID-19 pandemic contributed to a 53.6% increase in BMA visits, with spikes in late 2020 and 2021.

IN PRACTICE:

“This study underscores the importance of addressing factors that lead to patients leaving before medically advised from ED,” the authors wrote. “By implementing communication and quality-of-care–enhancing strategies in ED settings, policymakers, payors, and healthcare providers can contain leaving BMA and, in turn, lead to improved patient satisfaction and outcomes, while reducing the duplication of services, return visits, and downstream healthcare costs.”

SOURCE:

The study was led by Yahya Alnashri, MD, MPH, Department of Family & Community Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia. It was published online on 31 December, 2024, in The American Journal of Emergency Medicine.

LIMITATIONS:

The use of secondary data limited the available variables, and socioeconomic factors were not captured. Additionally, the reliance on hospital staff for survey data could have introduced reporting biases, while the retrospective design prevented causal conclusions.

DISCLOSURES:

The study did not receive any funding. The authors reported no known competing financial interests or personal relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.