Researchers: Eran Zaidise¹, Benidor Raviv ¹

Background: Patients who leave an Emergency Department (ED) without being seen, or against medical advice, make up for 1-15 percent of all ED patients. This phenomena is typically explained by institutional or contextual characteristics but further study is required regarding the patients characteristics and motives.

Objectives: This study attempts to further our understanding of ED walkouts, by focusing on individual and attitudinal characteristics of patients who’ve chosen to walk out of the ED.

Method: Structured telephone interviews were conducted over a year with 348 walkout patients, and 400 patients who have not walked out (N-738) of the ED at Western Galilee Medical Center in Northers Israel. Additional information was obtained from patients files and ED registry and analyzed with interview data.

Findings: Findings show that institutional and contextual data apply to this study as well. Like previous findings, we too find that walkouts are more likely occur when the ED is clouded, during the winter, on holidays and on weekends. However, individual/patient level characteristics play a role as well. We found that the two most important factors explaining a walkout decision are communication with doctors and nurses and perceived satisfaction. Also found significant were the patients personality traits, his/her self reported health level, and some socio-economic characteristics.

Conclusions: With institutional factors requiring ample resources to change dramatically, identifying which patients are at greater risk of walking out unseen, and addressing communication difficulties which lessen satisfaction may prove valuable to reducing the number of ED walkouts.

Recommendations: Policy makers at the national level should encourage hospitals to create programs to better measure and identify potential walkout patients. Additionally, staff training in communication should be encouraged to bring down frustration and dissatisfaction among ED patients.

Research end date: 11/2019