Pediatric Patients Who Leave the Emergency Department Without Treatment

Patient departure from the Emergency Department (ED) before completing the medical procedure (LWBS - Left Without Being Seen or Treated) is a well-known phenomenon in emergency medicine and can be dangerous, with severe medical consequences, particularly when the patient is unaware of their condition or has not received the necessary treatment. The ED is responsible for treating urgent cases, and thus, a patient's decision to leave before completing the evaluation and/or receiving appropriate care can lead to serious consequences related to undiagnosed or improperly treated illnesses or injuries. In addition, the patient may not receive the necessary discharge instructions, which could negatively affect their health, worsen their condition, cause irreversible damage, increase the rate of repeated visits, and even pose a risk of mortality.

Numerous studies have focused on the adult population, but very few have addressed children. In pediatric EDs, the responsibility for the decision to leave the department rests with the parent or guardian, which underscores the unique importance of understanding the factors that contribute to this decision. A previous study conducted in the adult emergency department at Hillel Yaffe Medical Center found that a low triage level and long wait times were significant predictors of early departure.

Similar findings have been reported in studies conducted in the U.S. and Canada, where the impact of long wait times, ED overload, younger age, time of arrival, low urgency, and self-arrival without a referral from a physician were emphasized as contributing factors . Other studies pointed to sociodemographic variables such as nationality, gender, socioeconomic status, and previous instances of early departure as additional risk factors.

A unique study conducted among Indigenous communities in Canada highlighted factors such as feelings of discrimination, lack of trust, and poor communication with medical staff as influential in the decision of parents to leave before completing treatment [5]. Additionally, a qualitative study conducted in the U.S. using Q-methodology (a method for identifying subjective patterns of thinking by sorting statements based on agreement or relevance) found that parents left due to a lack of updates on their position in the queue, unclear information about wait times, feelings of helplessness in the face of the child's pain, or external pressures such as work or caring for other children.

Since the decision to leave in children is made by the parent and not the patient, understanding the characteristics, circumstances, and factors involved is crucial. In Israel, where the healthcare system is publicly funded and based on the National Health Insurance Law, which provides access to clinics within health funds or emergency centers, there are unique parameters that affect access to hospital care-such as referral by a physician or payment for self-referred visits. Therefore, it is likely that local, cultural, and organizational factors influence the phenomenon of early departure, and these should be examined in the pediatric context.

Due to the lack of qualitative and quantitative studies on the issue of early departure from pediatric emergency departments, both globally and particularly in Israel, there is a need to complete research aimed at filling this knowledge gap. The main reason for conducting this research is the desire to identify recurring patterns and characteristics that predict early departure, which will enable early interventions that improve service quality, reduce the risk of early departure, and decrease the medical complications resulting from it. Additionally, this study may contribute to understanding the parents' perspectives, the relationship between parents' experiences in the ED and medical decision-making, and serve as a basis for future research, training medical staff, and improving the patient and caregiver experience alike.

Research Objectives:

To examine the clinical, operational, and demographic characteristics that influence the decision of patients to voluntarily leave the pediatric emergency department at Hillel Yaffe Medical Center before completing the evaluation or medical treatment.