Patients’ reasons for leaving an emergency department without being seen: results from a survey-based cohort study during the COVID-19 pandemic

Objective Patients who do not wait (DNW) to be seen are a problem for emergency department (ED) care. The aim of this study was to identify the rate and reasons of DNW patients during 1month of the COVID-19 pandemic. Methods An observational cohort study of DNW patients presenting to Austin Hospital ED was carried out in August 2021. Patients were identified using hospital coding data and surveyed by telephone. DNW patients' reasons were explored, and their demographics and clinical outcomes compared with those who received care. Results Of 7641 patients presenting to ED in the study period, 6% (n =452) were DNW patients. Compared with those who received care, DNW patients were younger (P <0.001), had lower triage categories (P =0.001) and were more likely to have self-presented (P =0.006). A total of 47% of DNW patients (n =213) participated in the survey. Reasons for leaving included waiting time (61%, n =129), symptom improvement (13%, n =28), reassurance from staff (7%, n =15) and ED crowding (6%, n =12). A total of 75% of DNW patients (n =159) sought alternative medical care; 14% (n =29) reported hospitalisation within 7days. 64% (n =137) did not feel that the experience affected their likelihood of seeking future ED care; 32% (n =69) felt less likely to seek future ED care. Conclusions During the month studied, the DNW rate was 6%. Reassuringly, most patients sought alternative medical care, although one-third were dissuaded from returning to the ED. Future research should focus on high-risk group delineation and qualitative description of the experiences and reasons of DNW patients.