DIFFUSE DEGENERATION OF THE CEREBRAL WHITE MATTER IN SEVERE DEMENTIA FOLLOWING HEAD INJURY

TLDR

The review sought to quantify the proportion of patients who leave the emergency department without being seen, identify their reasons, assess potential health risks, evaluate the impact of interventions on LWBS rates, and discuss its use as a national performance indicator. The authors conducted a realistic literature review, analyzed England’s hospital episode statistics, and audited a local NHS trust to gather data on LWBS. LWBS rates vary worldwide from 0.36 % to 15 %, interventions produce mixed reductions up to 96 %, the main driver is long waiting times, and evidence that LWBS poses a health risk is scant.

Abstract

<h3>Objectives</h3> The purpose of this review was to determine the rate of those that leave the emergency department (ED) without being seen and their reasons, to clarify if such behaviour poses a health risk, to analyse the impact initiatives have made on the leave without being seen (LWBS) rate, and to discuss the implications of using it as a national performance indicator within the NHS. <h3>Methods</h3> A combination of data sources was reviewed: a ‘realistic’ literature review, analysis of hospital episode statistics data from England and a local NHS trust audit. <h3>Major Findings</h3> LWBS rates vary across the world, from 15% to 0.36%. Also initiatives to reduce LWBS rates demonstrated mixed outcomes, with reductions in the rate by as much as 96%, while others were ineffective. The most common reason quoted for LWBS was long waiting times and there were few data to suggest LWBS posed a risk to patient health. <h3>Conclusions</h3> LWBS is an issue experienced in many countries that has responded in a varying manner to many initiatives in attempts to reduce it; however, it is clearly associated with the waiting times experienced in ED and therefore working within a packet of performance measures it would assess the effect of waiting times from another perspective.