Aims:

The determination of whether factors correlated with left without being seen incidence reported in literature apply in a highly privatized healthcare system of a third world country. To determine the proportion of left without being seen due to financial issues in comparison to other factors. 

Design:

The study will be a prospective pair matched case-control study of all patients who left without being seen from the emergency department (ED) between June 2016 and May 2017 in order to examine the influence of different patient characteristics on the likelihood of visit incompletion.

Study Endpoints:

Primary Outcome: Determination of correlation of financial issues to the decision to leave without being seen by a physician.

Secondary Outcome: evaluation of other factors listed in literature as predictors of the decision to leave without being seen. 

Patients eligible for enrollment under case group are those who are no longer present in the waiting area when called for placement in an ED room. Those selected for the control group are those that stayed and completed treatment either to be discharged afterwards or to be admitted.

Protocol: 

Enrolled patients have an entry time and leave time on their patient information forms. The entry time is the time recorded by the triage staff when patient is seen. The “left” time is time recorded by ED staff when patient is called for ED room placement but is not found and is, therefore, the latest possible time the patient could have left the emergency department since the exact leave time can not be accurately ascertained. Each case was matched to a control based on date and time (±2 hours) and triage level. Using the emergency department’s patient database, a list of the patients presenting to the emergency department at a similar time (matched date, matched admission hour ±2 hours) but completed the service, is retrieved, from which a control with a matching ESI is selected.  This was aimed to ensure that the matched pair has faced similar hospital and ED conditions during their visits. A single standardized phone survey with a list of questions is conducted within 4-8 days following ED visit. The aim of conducting the survey within a limited amount of time is to ascertain that patients are able to remember the details of the ED visit while allowing enough time for patients to seek alternative means of healthcare. Also recorded is the daily total ED patient volume, this will be correlated with the amount of LWBS patients reported at each corresponding day.