Patients Leaving EDs Without Being Seen Often Come Back

TOPLINE:

In this large cohort study, 18.5% of patients who left the emergency department (ED) without being seen returned within 7 days, with a significant proportion requiring hospitalization.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the Epic Cosmos dataset during the calendar year 2023, including adults aged ≥ 18 years who left without being seen (LWBS) from EDs.
• Analysis included data from more than 1500 hospitals and over 270 million patients across the United States.
• A total of 345,938 LWBS ED visits by 316,321 unique patients (mean age, 43.7 years; women, 55.7%) were included.
• Overall, 53% of patients were White, 34.6% were Black, and 9.9% were Hispanic; 13.2% arrived via emergency medical services.
• The primary outcome was the percentage of LWBS ED visits with at least one return visit within 7 days.

TAKEAWAY:

• Among the LWBS ED visits, 18.5% resulted in a return visit within 7 days, with 1.63% of those patients requiring hospitalization and 0.19% admitted to the intensive care unit.
• More than half (58.3%) of the return visits occurred at the same ED, often within 48 hours. The median time to a return visit was 46.6 hours.
• Secondary analysis revealed that 98,153 LWBS ED visits (28.4%) had at least one return visit within 30 days.

IN PRACTICE:

“Ongoing efforts to reduce return ED utilization among LWBS patients may benefit from alternative care options that meet patient needs, including outside traditional business hours,” the authors wrote.

SOURCE:

The study was led by Christopher Evans, MD, MPH, East Carolina University Health, Greenville, North Carolina. It was published online on January 6, 2025, in JAMA.

LIMITATIONS:

Return visits to EDs at hospitals outside EPIC Cosmos were not captured in the study, and ambulatory care utilization was not evaluated.

DISCLOSURES:

The authors did not report any funding source. Two authors reported receiving personal fees and support outside this work. No other disclosures were reported.

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