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Patients Who Presented to an Australian Emergency Department and Did Not Wait or Left Against Medical Advice: A Prospective Cohort Follow-Up Study

Crilly, Julia PhD, RN; Bost, Nerolie MN, RN; Gleeson, Heidi MN, RN; Timms, Jo MN, RN, NP

doi: 10.1097/TME.0b013e3182705efb
Cases of Note

This study aimed to describe characteristics, outcomes, and post–emergency department (ED) departure medical requirements of patients who did not wait (DNW) or left against medical advice (LAMA) after presenting to an Australian hospital ED over a 6-month period. This was a prospective cohort follow-up study. Children and adults were compared in terms of ED characteristics and outcomes. Of the 32,333 patient presentations, 3,293 (10.2%) were recorded as DNW and 470 (1.5%) as LAMA. Of the DNW/LAMA presentations, 1,303 (34.6%) received a telephone call. One in four of the DNW/LAMA patients were children (<16 years). Most (87%) waited longer than the recommended time before leaving the ED, the majority (56%) sought care elsewhere, and some (n = 174, 13%) re-presented to the ED within 7 days; 20 of those required hospital admission. Strategies addressing front-end ED systems are required to mitigate the proportion of patients who DNW/LAMA.

Statewide Emergency Department Clinical Network and Research Centre for Clinical and Community Practice Innovation, Griffith University (Dr Crilly and Ms Bost); and Emergency Department, Gold Coast Hospital (Mss Gleeson and Timms), Queensland, Australia

Corresponding Author: Julia Crilly, PhD, RN Emergency Department, Gold Coast Hospital, 108 Nerang Street, Southport, Queensland, 4215, Australia (

Disclosure: The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.