A recent study published on December 18 in the Journal of the American College of Emergency Physicians Open has shed light on the alarming trend of patients leaving emergency departments (ED) in Ontario without being seen (LWBS). Funded by the Canadian Institutes of Health Research, this study analyzed data from 2014 to 2023 to understand the temporal trends in ED and LWBS visits. The findings reveal a worrying increase in the rate of LWBS visits after April 1, 2020, with significant implications for patient health outcomes and the public healthcare system.
The research highlights that the rate of LWBS visits exceeded the baseline period's single-month maximum of 4% in 15 of the 36 months following April 2020. Furthermore, a higher proportion of these visits were categorized as emergent on the Canadian Triage and Acuity Scale during the recent period (12.9% compared to 9.2% in the baseline period). In contrast, fewer visits were labeled as semiurgent, dropping from 31.9% to 22.6%. The study underscores an increased risk for adverse outcomes: a 14% higher risk for death or hospitalization within seven days among patients who left without being seen after 2020. The risk for death alone was found to be 46% higher after this period.
“We need consistent, predictable, and sustained investment in our public healthcare system. We need long-term, consistent funding for primary care, ED care, as well as hospital and long-term care.” – Candace McNaughton, MD, PhD
Dr. Candace McNaughton emphasizes the urgency of addressing this issue through strategic healthcare investments. The study's findings suggest that the current situation demands not only immediate attention but also long-term solutions to prevent further deterioration.
The median age of patients during the baseline period was 40 years, which slightly increased to 42 years in the recent period. Despite this relatively young demographic, the study found that even 30 days after a LWBS ED visit, there remained a 5% increased risk for death or hospitalization and a 24% increased risk for death alone.
“It is important to note that people in our study were relatively young, with a median age in their 40s; this makes our findings all the more concerning. Clinicians should be aware that LWBS ED visits are not necessarily benign, particularly when rates of LWBS ED visits are high.” – Candace McNaughton, MD, PhD
Dr. McNaughton's insights highlight the critical nature of these findings and the potential implications for clinical practice. The study raises questions regarding geographic variations in risk, indicating a need for further investigation to comprehend these disparities fully.
“Emergency physicians like me always worry when patients leave without being seen,” – Jesse Pines, MD
Dr. Jesse Pines, reflecting on the study's outcomes, points out that some patients who leave without being seen suffer from critical life-threatening conditions requiring immediate care and hospitalization.
“some have critical life-threatening conditions that require care and hospitalization. The worry is that these patients experience poorer outcomes,” – Jesse Pines, MD
The study suggests that these outcomes are becoming increasingly common in Canada and possibly reflect broader trends seen elsewhere.
“Similar to what the authors found in their report, LWBS and other metrics — specifically boarding — have progressively increased in the United States, in particular, since the early part of 2021,” – Jesse Pines, MD
The article also underscores the importance of maintaining a consistent and robust healthcare workforce. Dr. McNaughton notes that it takes years to recruit and train healthcare professionals capable of providing high-quality medical care, emphasizing that there are no shortcuts to addressing these systemic challenges.
“It takes years to recruit and train the teams of people necessary to provide the high-quality medical care that Canadians have a right to. There are no shortcuts.” – Candace McNaughton, MD, PhD
Additionally, Dr. McNaughton points out that political factors have contributed to more frequent ED closures in Ontario since 2020, affecting an increasing number of Ontarians.
“Unfortunately, because of politics, since 2020, ED closures in Ontario have become more and more common and seem to be affecting more and more Ontarians,” – Candace McNaughton, MD, PhD
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