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Up to a Fifth of ER Patients Leave Without Being Seen

More leave without being seen in emergency departments treating low-income patients

FRIDAY, March 18 (HealthDay News) -- The percentage of patients in emergency departments who leave without being seen (LWBS) varies greatly across hospitals and is higher for emergency departments with more low-income and poorly insured patients, according to a study published online Feb. 21 in the Annals of Emergency Medicine.

Renee Y. Hsia, M.D., from the University of California in San Francisco, and colleagues analyzed data from 9.2 million emergency department visits to 262 hospitals to determine the proportion of visits to acute-care, nonfederal hospitals resulting in LWBS. The investigators also studied whether LWBS was affected by structural characteristics or socioeconomic status case-mix at the hospitals.

The investigators found that among visitors to emergency departments, the median LWBS was 2.6 percent, ranging from 0 to 20.3 percent between hospitals. A higher risk of LWBS was found in emergency departments with a higher proportion of low-income and poorly insured patients. The likelihood of an emergency department visit being LWBS increased by a factor of 1.15 for each 10 percent increase in patients who were poorly insured, and decreased by 0.86 for each $10,000 increase in household income. Hospitals with trauma center designation, county ownership, and teaching program affiliation were associated with elevated probability of LWBS (odds ratio, 2.09), and these factors reduced the association with insurance status.

"The increasing phenomenon of LWBS patients differentially affects those at hospitals that tend to serve the most vulnerable. Real action and resources should be applied to address these disparities on a systems level," the authors write.

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