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Emergency patients who leave without being seen: are urgently ill or injured patients leaving without care?

Against Medical Advice (AMA) patients present troubling legal liabilities for emergency medicine physicians. One subset of AMA patients, those who present for care but leave the emergency department prior to evaluation by a physician, represent a potential source of liability. A total of 291 consecutive "Left Without Being Seen" (LWBS) patients were retrospectively studied to see how many died, required admission, or returned for outpatient medical care within 7 days. Nearly half (44%) were found to seek repeat care at clinics or the Emergency Department. Only 5 of 291 (1.7%) required admission. There were no documented deaths. Because of the difficulty in reliably predicting which patients would choose to leave without being seen, an attempt was made to identify specific LWBS patients who would seek a return visit or require admission. With the exception of one specific age group (infants less than 12 months of age), or a chief complaint referable to the cardiovascular system, no presenting parameter of the LWBS patient, including sex, chief complaint, duration of chief complaint, wait in the emergency department, and vital signs, was significantly helpful in differentiating those patients who would later return or require admission.