More patients leaving emergency departments before being medically evaluated, study finds

An increasing number of patients are leaving emergency departments without being seen when facilities are crowded and wait times are long.

“These departures may have significant consequences for patients, given the associated delayed or deferred care for acute conditions,” according to a report in JAMA Network Open. “Patients from minority communities are more likely to depart before evaluation, with problems relatively concentrated among hospitals serving low-income populations. This occurs despite the increasing added value of emergency-based linkages to care for populations at increased risk, such as patients with opioid use disorder seeking medication treatment.”

Researchers sought to characterize how often patients left the emergency department before clinical evaluation over time using a national sample of U.S. hospitals. They find that the rate of patients who left without being seen increased from 1.1% in 2017 to 2.1% by the end of 2021. Among the worst-performing hospitals, the number who left before medical evaluation rose from 4.3% to 10% during the same period.

“Findings from this cross-sectional study demonstrate the failure of the emergency care system to maintain broad access in the context of pandemic demands, suggesting that existing regulatory and financial incentives may be inadequate to meet challenges of future pandemic waves and other disasters,” the report says.

Most solutions to date have used doctor-in-triage or split-flow models to offer faster medical screening evaluations, effectively bypassing traditional triage processes. These processes promote rapid but limited physician evaluations, often in the waiting room. Amid the current crisis, these ED-focused operational efforts may be inadequate to stem this growing problem, researchers say.

The report speculates that system strain may be associated with increased differences in leaving rates for hospitals serving low-income and underinsured patient populations.

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“Access to emergency care cannot be considered universal until all patients presenting to emergency departments receive high-quality treatment for time-sensitive conditions,” the report concludes. “Given contributing system constraints, leaving without being served should be viewed as a failure to offer equitable access to acute care, understood in the context of other measures of care access.”