Factors Associated with Patients Leaving Without Being Seen in a Canadian Emergency Department

TL;DR

This study identifies factors like age, gender, and ED crowding that influence patients leaving a Canadian emergency department without being seen.

Contribution

The study systematically evaluates both patient- and system-level factors affecting leaving-without-being-seen behavior in an ED.

Findings

Each additional 10 years of age reduces the odds of leaving without being seen by 20.2%.

Male patients have 9.4% higher odds of leaving without being seen compared to females.

ED crowding increases the odds of leaving without being seen by 16.9% per five additional waiting patients.

Abstract

Patients leaving without being seen is a critical quality metric for emergency department (ED) performance and is associated with negative patient outcomes and operational inefficiencies. In this study we aimed to systematically assess patient- and system-level factors influencing leaving-without-being-seen behavior.

We conducted a retrospective cohort study at The Ottawa Hospital, a tertiary-care ED with 85,000 annual ED visits in Ottawa, Canada. We analyzed all patient encounters for two years from May 2022–April 2024. Variables included demographics characteristics (age, sex), visit specifics (arrival day and time, Canadian Triage and Acuity Scale [CTAS] scores, presenting complaints), and operational metrics (ED occupancy metrics). Multivariate logistic regression analyses evaluated the influence of these factors on rates of leaving without being seen.

Of 170,536 ED visits, 15,473 (9.1%) patients left without being seen, and 2,716 (1.6%) left before triage. Each additional 10 years of age reduced the adjusted odds of leaving without being seen by 20.2% (older patients left less frequently). Male patients had 9.4% higher adjusted odds of leaving without being seen compared to females. For every five patients waiting to be seen, the adjusted odds of leaving increased by 16.9% for a newly arriving patient. For every five patients already seen but awaiting disposition, the adjusted odds of leaving increased by 9.6% for a newly arriving patient. Compared to CTAS 2 patients (high acuity), CTAS 3 patients had 67.1% higher adjusted odds of leaving, CTAS 4 patients had 134% higher adjusted odds, and CTAS 5 patients (lowest acuity) had 176% higher adjusted odds of leaving.

Younger age, male sex, lower acuity, and ED crowding independently and significantly increase rates of leaving without being seen. Importantly, both crowding and volume of patients waiting impact left-without-being-seen behaviour. Optimizing patient flow through strategic movement within the ED may enhance the perception of progress, encouraging patients to remain for care.