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Did Not Wait Patient Management Strategy (DNW PMS) Study
  1. Fran O'Keeffe,
  2. Sinead Cronin,
  3. Peadar Gilligan,
  4. Patrick O'Kelly,
  5. Aidan Gleeson,
  6. Patricia Houlihan,
  7. Sherif Kelada
  1. Emergency Department, Beaumont Hospital, Beaumont Road, Dublin, Ireland
  1. Correspondence to Dr Fran O'Keeffe, Department of Emergency Medicine, Alfred Hospital, Commercial Road, Prahran, Melbourne 3181, Australia; fokeeffe{at}


Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all ‘did not wait’ (DNW) patients' triage notes and the recall of at-risk patients.

Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.

Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall.

Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.

  • Clinical assessment
  • clincial management
  • did not wait
  • DNW
  • emergency care systems
  • emergency departments
  • environmental medicine
  • management
  • other
  • risk
  • risk management
  • paramedics

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  • Competing interests None.

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