Reasons and Features of Patients Who Leave the Emergency Department Without Being Seen

<b>Background:</b> Emergency medicine practitioners encounter significant challenges related to patients who leave emergency departments (EDs) without being seen (LWBS) in the ED. We aimed to assess the characteristics, reasons, and rate of patients who left without being seen in the tertiary teaching hospital ED of King Khalid University Hospital in Riyadh, Saudi Arabia. <b>Methods:</b> A qualitative prospective observational study was conducted from January 4, 2023, to May 17, 2023, among patients who left the ED without being seen in the King Khalid University Hospital, King Saud University Medical City, a tertiary hospital in Riyadh, Saudi Arabia. Data were collected from the ED administrative database, phone surveys, and electronic files of the identified patients. Phone interviews with questionnaires were conducted with patients participating in the study within 1 week of their ED visit. <b>Results:</b> During the study period, 16,682 patients visited the adult ED and 636 (3.81%) remained unseen; 300 patients met the study criteria. Of these, 288 (96%) arrived at the hospital via private car and 12 (4%) used ambulances. Trauma and gastrointestinal, neurological, and cardiovascular complaints were the most common, reported by 24.33%, 18.33%, 12%, and 10% of patients, respectively. In our study, 55 patients (18.3%) experienced prolonged waiting times of more than four hours before leaving the ED. Most patients (75%) inquired about the reasons for not being seen by a physician while waiting; 137 (45.6%) asked a receptionist, 117 (39%) asked a nurse, and 28 (9.3%) asked a doctor. According to 76 (25.3%) patients, they should not have to wait, whereas 82 (27.3%) said that they should wait for an hour. When asked whether they would visit the same ED in the future, 213 (71%) answered yes and 87 (29%) answered no. <b>Conclusion:</b> We conclude that in our center, prolonged waiting time and ED overcrowding are the main reasons why patients leave the ED without seeing a physician. Younger patients are more prone to LWBS, with trauma and gastroenterological complaints being the most common presenting symptoms. The LWBS rate was 3.81% of the total ED visits during the study period.