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Open Access Publications from the University of California

Original Research

Follow-Up Behavior of Patients Who Leave Without Being Seen from a Hybrid Point of Service Collection Emergency Department

Introduction: This study aims to assess follow-up behaviors of patients who leave without being seen (LWBS) from a hybrid point of service (POS) collection model Emergency Department (ED).

Methods: A cross-sectional survey was administered to patients who LWBS from a hybrid POS collection model ED, one-week post-ED visit, at an academic tertiary care medical center in Lebanon, between June 2016 and May 2017.

Results: LWBS patients were found to be young, males, and present with conditions of lower urgency and presenting mainly with a musculoskeletal chief complaint. Majority (66.8%) left because of third party payer denial of visit coverage followed by cost of visit (12.6%) and wait times (12.6%). A greater percentage of those who LWBS due to financial reasons were male (64.1% vs 33.3%, p <0.001) and waited less (23.4 min vs 30.8 min, p=0.08) compared to those who left for non-financial reasons. The majority of LWBS patients sought medical care within the week after leaving the ED (78.4%), primarily at ambulatory clinics (89.9%) with few at emergency departments (10.1%). Few required admission to hospital (4.2%) and no mortalities were reported. A greater percentage of those who left because of financial barriers, felt the same/better after leaving the ED (82.1% vs 66.7%, p=0.03), sought care at alternate sites (82.1% vs 66.7%, p=0.03), primarily ambulatory clinics (94.1%, p=0.003), with fewer requiring admission to the hospital within one well (1.4% vs 13.3%, p=003). Irrespective of the reason for LWBS, all patients who sought care at an ambulatory clinic, did so at a different institution (100.0%).

Conclusion: While the majority of patients who left without being seen from a hybrid POS collection ED left for financial reasons, a high percentage sought care at ambulatory clinics after leaving the ED.  Larger-scale studies are needed to adequately assess the outcomes of those patients, especially in areas with limited access to primary care ambulatory services.

 

Case Report

The Challenge Of Unilateral Leg Swelling In The Emergency Department

Unilateral calf swelling can pose a diagnostic challenge in the Emergency Department. There are several differential diagnoses for this presentation, and the management of one may be a contraindication for another. Point-of-care-ultrasound (POCUS) can be used to identify the aetiology and guide management with confidence. We present a case of an elderly patient with unilateral leg swelling in which DVT was initially suspected. However, POCUS demonstrated a ruptured Baker's cyst with associated calf haematoma. The use of POCUS by emergency physicians can avoid the consequences of unnecessary or harmful treatment and missed diagnosis of venous thromboembolic disease.