Too Many Unseen in Hospital Emergency Departments

A recent study suggests that as many as 20% of “would-be” emergency department patients in California leave the hospital before seeing a doctor. According to the study author Dr. Renee Y. Hsia, an assistant professor in the department of emergency medicine at the University of California, San Francisco: “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.”

Hsia’s findings will appear in the Annals of Emergency Medicine. According to the U.S. Centers for Disease Control and Prevention, in 2007 hospital emergency departments saw 117 million visits, and from that number, 18% were seen in less than 15 minutes. California represents 12% of the U.S. population, and statewide there has been an alarming trend of patients who leave an emergency department without being seen.

The authors utilized data collected by the State of California’s Office of Statewide Health Planning and Development (OSHPD).  Emergency departments located in lower income communities had more patients leaving the hospital before being seen. Not for profit hospitals averaged 2.5%, and the figure doubled at county-owned facilities. Teaching hospitals had twice as high of a rate as non-teaching hospitals, and trauma centers had a 3.9% rate compared with the rate of non-trauma centers (at 2.5%).

Hsia continued: “What’s important to combat here is the myth that the people who leave an ER aren’t that sick to begin with. 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, also added: “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. 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 soar throats and sprained ankles. 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.”