Patients who leave a public hospital emergency department without being seen by a physician: causes and consequences

Article Abstract:

For many people without health care insurance, emergency rooms in public hospitals are often the primary source of health care. Urban emergency rooms have become increasingly crowded in recent years, and there is some concern that they will not be able to handle the increased load. It is clear that some patients who arrive at an emergency room leave without having seen a physician. It has been suggested that the people who leave may simply be less patient than others, and that they may be less ill as well. However, data to substantiate this viewpoint are lacking. A study was undertaken to determine why people leave hospital emergency rooms without seeing a physician and to determine to what degree this might affect their health and well-being. A detailed follow-up was conducted of 186 people who signed in at an emergency room and then left before seeing a physician. The findings from this group were compared with those of 211 randomly selected people who did wait until they received medical attention. While both patient groups recalled similar periods of waiting (over six hours, on average), the actual records indicated that the patients who left had waited significantly longer than average. The medical conditions affecting those who left and those who waited were comparable. About 11 percent of the patients who left required hospitalization within a week, as did 9 percent of the patients who waited. In the present study, three of the patients who left required emergency surgery. In some cases, patients left after experiencing some decrease in their symptoms. However, in most cases, the patients left without seeing a physician because of difficulties with transportation, child care, or conflicts with work schedules. The patients who left without seeing a physician were found to be just as willing to wait as those who actually did wait, if circumstances allowed. These results demonstrate that the overcrowding of emergency rooms is closing yet another door through which the poor and uninsured can receive health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Hospital emergency services, Hospital outpatient services, Hospitals, Public, Public hospitals, Triage (Medicine)

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Maintaining hospital quality: the need for international cooperation

Article Abstract:

Modern hospitals are viewed from two different perspectives. One is that they provide treatment for patients with life-threatening conditions. The other is that the cost of hospital care is exorbitantly expensive and continues to increase. Patients should be careful to choose the hospital that will provide the highest quality of care. Different methods need to be developed to assess the quality of hospital care. Quality has three different components: appropriateness, excellence and satisfaction. The development of valid measurements to assess the quality of care is a complex and difficult task. It should be undertaken at an international level because of its complexity. Measurements should be developed to evaluate both the appropriateness of a procedure and its outcome.

International aspects, Column, Quality management, Hospitalization, Hospital care

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Health Literacy Among Medicare Enrollees in a Managed Care Organization

Article Abstract:

Many elderly patients may not be able to read or understand health information contained on items such as prescription bottles, consent forms, health education brochures and appointment slips. Researchers tested the reading ability and health literacy of 3,260 Medicare beneficiaries 65 years old or older. Thirty-four percent of the English-speaking and 54% of the Spanish-speaking patients had inadequate or marginal health literacy. Black race, older age, poor education, and blue collar occupation were associated with poor health literacy.

Evaluation, Testing, Literacy, Aged patients, Elderly patients, Health education

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