Introduction: Patients who present to the ED for care and leave without being seen (LWBS) represent a significant problem. The objective of this study was to determine why patients LWBS, how long they perceived waiting versus actual time waited before leaving, and factors that might have prevented LWBS.Methods: We conducted a prospective, scripted phone survey of all patients who left without being seen over a two-month period in 2006 at an ED with approximately 65,000 yearly visits. Outcome measures were number leaving, ability to obtain care after leaving, reason for leaving, would they return to this ED, perceived and actual time waited, number with a primary physician, and factors associated with leaving.Results: One-hundred and twenty-seven of 11,147 total patients (1.1%) patients left without being seen. Seventy-two (56.7%) were interviewed within 8 days. Eighty-four and seven-tenths percent stated they had a primary physician. The mean age was 29.9 years, and 44.4% were male. The patient-reported mean time waited before leaving was 73.2 minutes while the actual mean time waited was 70.4 minutes. The reasons for leaving were the length of wait (76.7%), the problem resolved (12.3%), and for other reasons (11.0%). During the week after leaving the ED, 56.3% were able to obtain medical care. Sixty-five percent would seek future emergency care at this ED, 15.3% would not, and 19.7% would possibly return. During the wait, patients wanted information, lab tests/X-rays, and analgesics.Discussion: Most would return for future ED care. Most had a physician and were able to obtain care elsewhere. Reduced LWBS might be accomplished by triage testing, communication and attention to pain.

: The Institute of Medicine makes the case that patient safety data are a critical input for redesigning care processes in ways that will make health care safer. Mandatory and voluntary error-reporting systems are sources of such data. However, a chasm of legal and practical problems exists between the collection of error reports and responding to reporting providers to improve the quality and safety of the systems in which they work. Between 2000 and 2004, the American Academy of Family Physicians (AAFP) developed and tested a voluntary error-reporting system. In this paper we discuss the current design of the AAFP's system and the legal and practical constraints that stand in the way of its becoming a more robust quality-improvement tool. We explain decisions to make the reporting system Web-based (rather than paper-based), to be anonymous (rather than confidential), to not provide direct or specific feedback to reporters, and to make it capable of receiving reports of both sentinel events and intensive reporting. This paper will clarify what is currently done with error reports and how, despite current limitations, the reporting system informs and promotes a variety of other quality initiatives of the AAFP. We also highlight how this reporting system could more robustly improve patient safety and quality in health care if legislative and other remedies are implemented to bridge the existing chasm.

Numerous studies have reported relationships between gender and cerebral event-related potentials (ERPs) recorded from the human scalp. Recent studies have suggested that the influences of gender on ERPs may differ in persons with schizophrenia compared to healthy controls. In a further evaluation of the influences of this critical subject variable on ERP characteristics in schizophrenia, ERPs of age- and gender-matched groups (n = 72 each) of unmedicated schizophrenic patients and healthy controls were compared. ERPs elicited by left and right median nerve stimulation, checkerboard pattern visual flash, and auditory clicks were recorded from 15 scalp leads. The results confirm previous findings showing that: (1) number of comparable gender effects present in the ERP records of these two large study groups and (2) specific Diagnosis x Gender interactions suggesting that schizophrenic illness may modify normal gender influences on ERP characteristics. These data illustrate the point that matching schizophrenic patients and healthy control populations for gender is essential but not sufficient. Even in carefully matched groups, gender confounding can persist as a source of error variance because the influence can vary for different diagnostic groups.