702 - Short-Term Outcomes of Patients With Atypical Discharge From the Emergency Department
Thursday, May 14, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Patients with atypical discharge from the emergency department (left without being seen, against medical advice, elopement) are considered to be potentially at higher risk for adverse outcomes due to the fact that they have generally had an incomplete evaluation. We initiated a quality improvement process where we contact all of our atypical discharges by an ED case manager within 24 hours of departure from the ED, and again 7 days after their initial ED visit. We sought to determine their short-term outcomes.
Methods: The setting was a 27,000 visit Veterans Health Administration emergency department. We reviewed the atypical discharge logs from January 1-June 30, 2019. Logs of all atypical discharges are generated on a daily basis and the case manager attempts to contact the patient by phone numbers included in the demographic section of the chart. Information obtained on these logs included chief complaint, reason for atypical dc (waited too long, felt better, etc), their current state of health relative to their reason the ED visit (better/worse/same) and their plans for further care (return to VA ED, outside ED, PCP). Patients were recontacted at day 7 to obtain further information regarding their short-term outcomes.
Results: There were 633 atypical discharges during the study period. There were 404 left without being seen (64%); 122 eloped (19%); and 107 AMA (17%). 500 were able to be contacted within 24 hours (79%), this rose to 540 at the 7 day mark (85%). The primary reason for atypical discharge across all types was wait time (379, 60%), with transportation concerns, feeling better, or need to care for a pet/relative or other personal reason comprising the remainder. Of those with atypical dc, 179 (28%) sought care at the VA ED in the next week, 153 (24%) saw their primary care physician and 77 (12%) sought care at a non-VA site. The remainder did not seek further care or were unable to be contacted (11.5%). There were no deaths and 43 (6.8%) were admitted to a hospital within 7 days.
Conclusion: Wait time remains the single largest factor in determing who will have an atypical discharge from the emergency department. In our setting, we were able to follow-up with the majority of patients, and though there wee no deaths within thet 7 days follow-up, a small but significant percentage were admitted within 7 days of their atypical discharge.