[Premature departure from pediatric emergency department: retrospective analysis and preventive strategies.]

Abstract

. Premature departure from pediatric emergency department: retrospective analysis and preventive strategies.\n\n\nINTRODUCTION\nThe overcrowding of Emergency Departments (EDs) is a major cause of increased waiting time for the medical evaluation and dissatisfaction of children and their families, who often decide to leave before the visit is completed.\n\n\nAIM\nTo describe the characteristics of children who leave a second-level Pediatric ED before the medical examination.\n\n\nMETHODS\nRetrospective descriptive analysis of children who leave before the medical evaluation at the ED of the Regina Margherita Children s Hospital of Turin, Italy between June and November 2018. Data were obtained from the Hospital s informatic registry.\n\n\nRESULTS\n1351 children left the ED during the study period (6.7% of total visits); 9 of them (0.7%) had received a high triage priority code. The highest leaving rate was recorded in November, on the evening-slot and in children ageing 1-10 years. The average and median waiting time of those who left the ED before the medical examination were respectively 131 and 124 minutes. Fever and gastrointestinal problems were the most frequent reasons of access. Overall, 19.8% of children received nursing care during the triage. The revolving door rate was 6.0%.\n\n\nCONCLUSION\nLow priority of urgency, long waiting times, access during periods of increased influx and the age between 1 and 10 years were major factors leading to leave Pediatric ED before the medical evaluation. Further studies are needed to investigate how many early leavings are due to ineffective nursing in the triage setting.