Original Article

Reasons Military Patients With Primary Care Access Leave an Emergency Department Waiting Room Before Seeing a Provider

Authors: Shawn M. Varney, MD, Toni E. Vargas, PA-C, Rebecca L. Pitotti, RN, MSN, Vikhyat S. Bebarta, MD

Abstract

Objectives: Our objective was to assess patients’ understanding of emergency department (ED) wait times and why patients may leave the waiting room before seeing a provider.


Methods: Survey of patients in the ED waiting room of an urban tertiary care military hospital where civilian and military patients are treated.


Results: A total of 508/517 surveys (98%) were completed. Age ranges were 18 to 35 years (49%), 36 to 60 (31%), or older than 60 (20%). Education levels were high school (20%), some college (37%), or college graduate (39%). Of 503 respondents, 125 (25%) had left an ED waiting room before seeing a provider. The reasons included excessive wait times (91%) and family responsibilities (5%). Five hundred eight reported the factors that would motivate them to wait to see the physician (not leave without being seen [LWOBS]) were the severity of illness (64%), and if they received an update of wait times (26%); 82% (391/480) understood that severely ill patients were seen first. Patients attributed long wait times to doctors and nurses caring for other patients (292/583, 50%) and insufficient physician and nurse staffing (245, 42%). Of 802 responses for ideas to improve the wait, 34% said regular updates on estimated wait times, 21% said television shows or movies to view, 20% said books and magazines to read, and 11% said computers to access.


Conclusions: Long wait times were the primary reason that patients left before seeing a provider, despite having ready access to care. Respondents attributed long wait times to patient volume and inadequate staffing. Regular updates on wait times and material for entertainment may improve the waiting experience and reduce LWOBS.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Baker DW, Stevens CD, Brook RH. Patients who leave a public hospital emergency department without being seen by a physician. JAMA 1991; 266: 1085–1090.
 
2. Bindman AB, Grumbach K, Keane D, et al. Consequences of queuing for care at a public hospital emergency department. JAMA 1991; 266: 1091–1096.
 
3. Chan TC, Killeen JP, Kelly D, et al. Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Ann Emerg Med 2005; 46: 491–497.
 
4. De Lorenzo RA. Emergency department use of military beneficiaries. Am J Emerg Med 2009; 27: 1104–1108.
 
5. Levsky ME, Young SE, Masullo LN, et al. The effects of an accelerated triage and treatment protocol on left without being seen rates and wait times of urgent patients at a military emergency department. Mil Med 2008; 173: 999–1003.
 
6. Arendt KW, Sadosty AT, Weaver AL, et al. The left-without-being-seen patients: what would keep them from leaving? Ann Emerg Med 2003; 42: 317–323.
 
7. Holm L, Fitzmaurice L. Emergency department waiting room stress: can music or aromatherapy improve anxiety scores? Pediatr Emerg Care 2008; 24: 836–838.
 
8. McMullen JT, Veser FH. Emergency department volume and acuity as factors in patients leaving without treatment. South Med J 2004; 97: 729–733.
 
9. Fernandes CM, Price A, Christenson JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997; 15: 397–399.
 
10. Welch SJ, Allen TL. Data-driven quality improvement in the emergency department at a level one trauma and tertiary care hospital. J Emerg Med 2005; 30: 269–276.
 
11. Burt CW, Arispe IE. Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. Vital Health Stat 2004; 13: 155.
 
12. Fernandes CM, Daya MR, Barry S, et al. Emergency department patients who leave without seeing a physician: the Toronto Hospital experience. Ann Emerg Med 1994; 24: 1092–1096.
 
13. Xie B, Youash S. The effects of publishing emergency department wait time on patient utilization patterns in a community with two emergency department sites: a retrospective, quasi-experiment design. Int J Emerg Med 2011; 4: 29.
 
14. Dolan PL. Emergency departments offer online updates on wait times. http://www.ama-assn.org/amednews/2009/10/19/bisb1019.htm. Accessed February 21, 2012.
 
15. Landro L. Informed patient: cutting wait times in the emergency room.http://blogs.wsj.com/health/2011/08/02/cutting-wait-times-in-the-emergency-room. Accessed February 21, 2012.
 
16. Overlake Hospital Medical Center wait times. http://www.overlakehospital.org/mobile/ed-wait-time. Accessed February 22, 2012.
 
17. Civista Medical Center. Emergency. http://www.civista.org/fuseaction-MedicalServices.showMedicalServices-intServiceID-13.htm. Accessed February 21, 2012.
 
18. Parker B. Check online for hospital emergency room wait times in Cambridge, Somerville, Everett.http://www.boston.com/yourtown/news/cambridge/2011/02/check_cambridge_hospital_emerg.html. Accessed February 21, 2012.
 
19. In an emergency what matters most: faster or better? How about both? http://Arizonaer.com. Accessed February 23, 2012.
 
20. Weiner SJ, Vangeest JB, Abrams RI, et al. Avoiding free care at all costs: a survey of uninsured patients choosing not to seek emergency services at an urban county hospital. J Urban Health 2006; 83: 244–252.
 
21. Horwitz LI, Green J, Bradley EH. United States emergency department performance on wait time and length of visit. Ann Emerg Med 2010; 55: 133–141.
 
22. Thompson DA, Yarnold PR, Williams DR, et al. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med 1996; 28: 657–665.
 
23. Boudreaux ED, Friedman J, Chansky ME, et al. Emergency department patient satisfaction: examining the role of acuity. Acad Emerg Med 2004; 11: 162–168.
 
24. Monzon J, Friedman SM, Clarke C, et al. Patients who leave the emergency department without being seen by a physician: a control-matched study. CJEM 2005; 7: 107–113.
 
25. O’Reilly KB. Posting emergency wait times: good marketing or good medicine?http://www.ama-assn.org/amednews/2010/10/11/prl21011.htm. Accessed February 21, 2012.
 
26. Ding R, McCarthy ML, Li G, et al. Patients who leave without being seen: their characteristics and history of emergency department use. Ann Emerg Med 2006; 48: 686–693.
 
27. Mohsin M, Forero R, Ieraci S. A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emerg Med J 2007; 24: 175–179.