Acceso usuarios
Mar Ortega Romero, María J. Esteban, Óscar Miró Andreu, Miquel Sánchez Sánchez, José Millá Santos
Fundamento: Definir el perfil epidemiológico, los motivos y la evolución posterior de los enfermos que abandonan la unidad de urgencias de medicina sin ser atendidos.
Pacientes y método: Durante 26 semanas consecutivas se identificaron de forma prospectiva los pacientes que abandonaron la unidad de urgencias de medicina antes de ser atendidos. Por cada paciente no atendido (NA) se incluyó como control (C) el siguiente enfermo visitado en la unidad. Mediante los datos de la historia clínica y entrevista personal de pacientes NA y C, se recogieron variables clinicoepidemiológicas y, en los pacientes NA, los motivos que le condujeron a abandonar urgencias y su evolución posterior.
Resultados: De los 21.022 pacientes que acudieron a urgencias, 383 (1,8%) fueron NA. La edad inferior a 50 años, haber acudido a urgencias solo, no haber consultado previamente con un médico y una expectativa de tiempo de espera corto aumentan el riesgo de abandonar urgencias sin ser atendidos (p < 0,01, p < 0,01, p < 0,05 y p < 0,0001, respectivamente). Como razón principal para abandonar el servicio de urgencias, un 35% refirió encontrarse mejor, un 30% se encontraba demasiado mal para esperar más, y el 25% estaba muy enfadado para seguir esperando. Un 46% de NA buscó atención médica durante las siguientes 72 h y, en total, un 6,5% requirió ingresar, resultando ser los pacientes cuyos trastornos fueron valorados a su llegada como graves y los que habían consultado previamente a un médico aquellos con mayor riesgo de ingresar (p = 0,01 y p = 0,001, respectivamente).
Conclusiones: El enfermo que se va de urgencias antes de ser atendido suele ser un paciente relativamente joven, con estudios, que acude a urgencias sin consultar previamente con un médico y con síntomas de enfermedad menor. La principal causa de marcharse es la percepción de su propia enfermedad como no grave; menos de la mitad consulta posteriormente con un médico y su índice de ingresos es relativamente bajo. Se debería ser especialmente cauto con los pacientes que son remitidos por otro médico y que se valoran como graves a su llegada al hospital, ya que son los de mayor riesgo de ingresar posteriormente.
Background: To define epidemiological characteristics, the main reasons, and outcome of patients who leave the emergency department (ED) without being seen by a physician.
Patients and methods: We performed a prospective survey of patients who left the ED before medical visit over a period of 26 consecutive weeks. For every non-visited patient (NV), the next visited patient (V) was included as a control. Clinical and epidemiological data, reasons to leave ED and outcome were obtained from clinical records and personal telephonic interview.
Results: Out of a total of 21.022 patients who were attended in the ED, 383 (1.8%) were NV. To be under 50-year-old, to come the ED alone, to be previously visited by a community physician, and to previous expect short waiting times for ED visit were associated with higher risk for being NV (p < 0.01, p < 0.01, p < 0.05 and p < 0.0001, respectively). The main reasons noted to leave the ED were: feeling better (35%), feeling too sick to wait longer (30%) and being too angry to wait (25%). Only 46% of the NV looked for medical care in the 72 following hours and 6.5% of them needing to be further to hospital. NV-patients considered as suffering a serious pathology at ED arrival, and those being visited by a community physician previously to go to ED were found to be at increased risk to be subsequently admitted (p = 0.01 and p = 0.001, respectively).
Conclusions: Patients who leave ED department before being seen by a doctor are usually young, literate, have not previously visited their community physician, and consulted for minor complaints. The main reason to leave is their own impression of suffering a minor disease, and less than 50% visit another physician after their leaving, being the rate of hospital admission low. We should be particularly cautious with those patients referred by a community doctor and those identified as to have a seriously affected health status at their arrival at the hospital, since they are at increased risk to be admitted
