1 in 5 Patients at California ERs Leaves Without Being
FRIDAY, March 4 (HealthDay News) -- Upwards of one-fifth of
patients who seek care at one of California's hospital emergency
departments leave before being seen by anyone, new research
Rates of "leaves without being seen" varied widely across the
state and according to the type of facility in question. And while
the study authors said their results can't be extrapolated to the
rest of the nation, the trend does seems to be hitting
disadvantaged patients the hardest.
"This is concerning to us as both providers and consumers because these are patients who decided they need care, and we're not able to provide service to them," said study author Dr. Renee Y. Hsia, an assistant professor in the department of emergency medicine at the University of California, San Francisco, as well as an attending physician in the emergency department of San Francisco General Hospital.
Her team found the highest degree of unattended, would-be ER
patients at teaching hospitals, county-owned hospitals and trauma
centers, all of which experienced about double the rate of unseen
patients as other facilities.
The problem appears to be worst among the poorest patients and
those most likely to lack insurance coverage. "This either means
that over-crowding is the problem, or that these patients have a
tendency to walk out more than others," Hsia added. "For now this
is just a snapshot, and we don't know the underlying factors at
work here yet."
Hsia and her colleagues report their findings in the Feb. 22
online issue of the
Annals of Emergency Medicine.
According to the U.S. Centers for Disease Control and
Prevention, in 2007 (the same year focused on by the study authors)
there were nearly 117 million visits to the nation's ERs. Of those,
18 percent of the patients were seen in less than 15 minutes, and
more than 12 percent of all visitors ended up being admitted to the
California accounts for 12 percent of the nation's population
and 7 percent of its hospital market, Hsia's team noted. And over
the past 15 years, there's been a steady rise in the number of
patients who leave an ER without being seen. That trend has been
blamed on a variety of factors, including a drop in general access
to care and crowding caused by ER closures, often in lower-income
To explore the specific state of affairs in California, the
authors analyzed information obtained from the California Office of
Statewide Health Planning and Development database. The data
covered all 9.2 million emergency department visits that took place
at all 262 non-federally run hospitals across the state during
Patient income, as well as the affluence of the surrounding
community, seemed to play a major role in the findings. ERs in
poorer communities had higher rates of patient departures than
those located in higher income communities, the study found.
Specifically, for every increase of $10,000 in average household
income, there was an associated drop in the number of patients who
went unseen by ER staff.
Communities with worse insurance coverage also experienced
higher rates of unseen patients.
The percentage of people who left emergency departments without
being attended to ranged from 0 percent to more than 20 percent,
depending on the facility, the report found.
While non-profit hospitals had an average unseen patient rate of
2.5 percent, that figure was twice as high at county-owned
hospitals. Similarly, teaching hospitals had more than double the
rate of non-teaching hospitals (5.1 percent vs. 2.5 percent), while
trauma centers had a 3.9 percent rate compared with 2.5 percent at
While Hsia emphasized that more work needs to be done to better
understand what's driving people to skip the care they initially
felt they needed, she characterized the situation as "serious."
"What's important to combat here is the myth that the people who leave an ER aren't that sick to begin with," she stressed. "That's certainly not true. Most people go to the ER only because they have to. Nobody really wants to go. So it's a sad thing when they make that decision to go, and they need care, and they can't get it."
Dr. Marshall Morgan, chief of emergency medicine at the Ronald
Reagan UCLA Medical Center in Los Angeles, concurred.
"I think it's a big mistake for people to assume that the people who are leaving the ERs are people who don't have serious problems," he said. "In fact, it's been shown in other research that among the people who are leaving a certain percentage were seriously ill, as witnessed by their having to come back and be admitted within a few days."
"So we're not just talking about the people with sniffles and sore throats and sprained ankles," Morgan noted. "And this is a very big number. And whether it's because of a general increase in overall volume at ERs across the state due to the general economic issues the country faces today, or for some other reason, it's certainly a very big problem."
There's more statistics on U.S. emergency department visits at
U.S. Centers for Disease Control and
Copyright © 2011
. All rights reserved.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.