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An ED paradox: patients who arrive by ambulance and then leave without consulting an ED provider
  1. Malcolm B Doupe1,2,3,
  2. Suzanne Day4,
  3. Wes Palatnick5,
  4. Alecs Chochinov5,
  5. Dan Chateau6,
  6. Carolyn Snider5,
  7. Ricardo Lobato de Faria7,
  8. Erin Weldon5,
  9. Shelley Derksen8
  1. 1Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
  3. 3College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Women's Xchange, Women's College Hospital, Toronto, Ontario, Canada
  5. 5Faculty of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6Faculty of Medicine, Department of Community Health Sciences, Manitoba Centre for Health Policy (MCHP), University of Manitoba, Winnipeg, Manitoba, Canada
  7. 7Winnipeg Regional Health Authority, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
  8. 8Faculty of Medicine, Manitoba Centre for Health Policy (MCHP), University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Malcolm B Doupe, College of Medicine, Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 3P5; malcolm_doupe{at}cpe.umanitoba.ca

Abstract

Background Scientists have called for strategies to identify ED patients with unmet needs. We identify the unique profile of ED patients who arrive by ambulance and subsequently leave without consulting a provider (ie, a paradoxical visit, PV).

Methods Using a retrospective cohort design, administrative data from Winnipeg, Manitoba were interrogated to identify all ED patients 17+ years old as having zero, single or multiple PVs in 2012/2013. Analyses compare the sociodemographic, physical (eg, arthritis), mental (eg, substance abuse) and concurrent healthcare use profile of non-PV, single and multiple PV patients.

Results The study cohort consisted of 122 639 patients with 250 754 ED visits. Across all ED sites, 2.3% of patients (N=2815) made 3387 PVs, comprising 1.4% of all ED visits. Descriptively, more single versus non-PV patients lived in urban core and lowest-income areas, were frequent ED users generally, were substance abusers and had seven plus primary care physician visits. Multiple PV patients had a similar but more extreme profile versus their single PV counterparts (eg, 54.7% of multiple vs 27.4% of single PV patients had substance abuse challenges). From multivariate statistics, single versus non-PV patients are defined uniquely by their frequent ED use, by their substance abuse, as living in a core and low income area, and as having multiple visits with primary care physicians.

Conclusions PV patients have needs that do not align with the acute model of ED care. These patients may benefit from a more integrated care approach likely involving allied health professionals.

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Footnotes

  • Contributors MBD planned the study, supervised data analyses, wrote drafts and approved the final paper. SD assisted with the writing of all drafts and the final version of the paper. WP helped plan the study and provided detailed revisions to the paper. DC helped plan the study and provided detailed input into statistical analysis. CS, RLdF, EW and AC each contributed to revising various versions of the paper. SD provided all data analyses and contributed to revising the paper.

  • Funding This research was supported by an unrestricted research grant provided by Manitoba Health (HIPC # 2005/2006-15).

  • Competing interests All intellectual properties of this manuscript are solely those of the lead and contributing authors.

  • Ethics approval University of Manitoba Health Research Ethics Board, Bannatyne Campus (file # H2005:153).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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