Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review
Abstract Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency departm...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12873-019-0273-y |
| _version_ | 1819021787149631488 |
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| author | Carolin Hoyer Patrick Stein Angelika Alonso Michael Platten Kristina Szabo |
| author_facet | Carolin Hoyer Patrick Stein Angelika Alonso Michael Platten Kristina Szabo |
| author_sort | Carolin Hoyer |
| collection | DOAJ |
| description | Abstract Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED. |
| first_indexed | 2024-12-21T04:12:39Z |
| format | Article |
| id | doaj.art-b76570bf930145c48344ce67d1e1e112 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-21T04:12:39Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-b76570bf930145c48344ce67d1e1e1122022-12-21T19:16:25ZengBMCBMC Emergency Medicine1471-227X2019-10-011911810.1186/s12873-019-0273-yUncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart reviewCarolin Hoyer0Patrick Stein1Angelika Alonso2Michael Platten3Kristina Szabo4Department of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg UniversityDepartment of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg UniversityDepartment of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg UniversityDepartment of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg UniversityDepartment of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg UniversityAbstract Background Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. Methods A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Results Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Conclusions Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.http://link.springer.com/article/10.1186/s12873-019-0273-yNeurologyEmergency departmentPatient discharge |
| spellingShingle | Carolin Hoyer Patrick Stein Angelika Alonso Michael Platten Kristina Szabo Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review BMC Emergency Medicine Neurology Emergency department Patient discharge |
| title | Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review |
| title_full | Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review |
| title_fullStr | Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review |
| title_full_unstemmed | Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review |
| title_short | Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review |
| title_sort | uncompleted emergency department care and discharge against medical advice in patients with neurological complaints a chart review |
| topic | Neurology Emergency department Patient discharge |
| url | http://link.springer.com/article/10.1186/s12873-019-0273-y |
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