Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020
Abstract Objective To examine risks of severe adverse patient outcomes shortly after a left‐without‐being‐seen emergency department (LWBS ED) visit since 2020. Methods In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for...
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Elsevier
2024-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13299 |
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| author | Candace D. McNaughton Peter C. Austin Anna Chu Maria Santiago‐Jimenez Emily Li Jessalyn K. Holodinsky Noreen Kamal Mukesh Kumar Clare L. Atzema Manav V. Vyas Moira K. Kapral Amy Y. X. Yu |
| author_facet | Candace D. McNaughton Peter C. Austin Anna Chu Maria Santiago‐Jimenez Emily Li Jessalyn K. Holodinsky Noreen Kamal Mukesh Kumar Clare L. Atzema Manav V. Vyas Moira K. Kapral Amy Y. X. Yu |
| author_sort | Candace D. McNaughton |
| collection | DOAJ |
| description | Abstract Objective To examine risks of severe adverse patient outcomes shortly after a left‐without‐being‐seen emergency department (LWBS ED) visit since 2020. Methods In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient‐level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7‐day all‐cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index. Results Despite fewer monthly ED visits since 2020, temporal trends revealed sustained increases in monthly LWBS rates. LWBS ED visits after April 1, 2020 exceeded the baseline period's single‐month LWBS maximum of 4.0% in 15 out of 36 months. The composite outcome of 7‐day all‐cause mortality or hospitalization was 3.4% in the recent period versus 2.9% in the baseline period (adjusted risk ratio [aRR] 1.14, 95% confidence interval [CI] 1.11‒1.18) and remained elevated at 30 days (6.2% vs. 5.8%, respectively; aRR 1.05, 95% CI 1.03‒1.07), despite similar rates of post‐ED outpatient visits (7‐day recent and baseline: 38.9% and 39.7%, respectively, p = 0.38; 30‐day: 59.4% and 59.7%, respectively, p = 0.05). Conclusions The rate of short‐term mortality or hospitalization after a LWBS ED visit has recently increased, despite fewer ED visits/month and similar proportion of post‐ED outpatient encounters. This concerning signal should prompt interventions to address system‐ and population‐level causes. |
| format | Article |
| id | doaj-art-b7fd202f220f41b9af9d5ea1d28bc840 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-b7fd202f220f41b9af9d5ea1d28bc8402025-08-20T03:05:13ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522024-12-0156n/an/a10.1002/emp2.13299Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020Candace D. McNaughton0Peter C. Austin1Anna Chu2Maria Santiago‐Jimenez3Emily Li4Jessalyn K. Holodinsky5Noreen Kamal6Mukesh Kumar7Clare L. Atzema8Manav V. Vyas9Moira K. Kapral10Amy Y. X. Yu11Department of Medicine (Emergency Medicine) University of Toronto Sunnybrook Health Sciences Centre Toronto Ontario CanadaICES Toronto Ontario CanadaICES Toronto Ontario CanadaICES Toronto Ontario CanadaSunnybrook Research Institute Toronto Ontario CanadaDepartments of Emergency Medicine, Community Health Sciences, and Clinical Neurosciences, Center for Health Informatics, O'Brien Institute for Public Health Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary Calgary Alberta CanadaDepartment of Industrial Engineering Dalhousie University Halifax Nova Scotia CanadaDepartment of Industrial Engineering Dalhousie University Halifax Nova Scotia CanadaDepartment of Medicine (Emergency Medicine) University of Toronto Sunnybrook Health Sciences Centre Toronto Ontario CanadaICES Toronto Ontario CanadaICES Toronto Ontario CanadaICES Toronto Ontario CanadaAbstract Objective To examine risks of severe adverse patient outcomes shortly after a left‐without‐being‐seen emergency department (LWBS ED) visit since 2020. Methods In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient‐level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7‐day all‐cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index. Results Despite fewer monthly ED visits since 2020, temporal trends revealed sustained increases in monthly LWBS rates. LWBS ED visits after April 1, 2020 exceeded the baseline period's single‐month LWBS maximum of 4.0% in 15 out of 36 months. The composite outcome of 7‐day all‐cause mortality or hospitalization was 3.4% in the recent period versus 2.9% in the baseline period (adjusted risk ratio [aRR] 1.14, 95% confidence interval [CI] 1.11‒1.18) and remained elevated at 30 days (6.2% vs. 5.8%, respectively; aRR 1.05, 95% CI 1.03‒1.07), despite similar rates of post‐ED outpatient visits (7‐day recent and baseline: 38.9% and 39.7%, respectively, p = 0.38; 30‐day: 59.4% and 59.7%, respectively, p = 0.05). Conclusions The rate of short‐term mortality or hospitalization after a LWBS ED visit has recently increased, despite fewer ED visits/month and similar proportion of post‐ED outpatient encounters. This concerning signal should prompt interventions to address system‐ and population‐level causes.https://doi.org/10.1002/emp2.13299all‐cause mortalityemergency departmenthealthcare utilizationleft‐without‐being‐seen |
| spellingShingle | Candace D. McNaughton Peter C. Austin Anna Chu Maria Santiago‐Jimenez Emily Li Jessalyn K. Holodinsky Noreen Kamal Mukesh Kumar Clare L. Atzema Manav V. Vyas Moira K. Kapral Amy Y. X. Yu Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 Journal of the American College of Emergency Physicians Open all‐cause mortality emergency department healthcare utilization left‐without‐being‐seen |
| title | Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| title_full | Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| title_fullStr | Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| title_full_unstemmed | Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| title_short | Turbulence in the system: Higher rates of left‐without‐being‐seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| title_sort | turbulence in the system higher rates of left without being seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020 |
| topic | all‐cause mortality emergency department healthcare utilization left‐without‐being‐seen |
| url | https://doi.org/10.1002/emp2.13299 |
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