Patients who present to the Emergency department but do not wait : an exploratory study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University

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Massey University
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People who do not require urgent treatment often visit Emergency Departments. Furthermore, a small - yet significant - group leave the Emergency Department (ED) before even being seen by a doctor. Previous studies suggest that most people who do not wait (DNW) having presented to the ED and then leave without being seen by a doctor may have non-urgent conditions. However, other studies contradict this. This is an exploratory study into this subject. Its main aims are to: □ correctly define this DNW group who present to EDs; □ identify the size of a DNW population in a New Zealand setting; □ establish common factors that influence people's decision to present then leave and; □ ascertain whether nursing practice may impact on this population of emergency presentations. Data collection took place, over a period of 4 months, in a Level 5 District Health Board Emergency Department in New Zealand. The study uses a retrospective cross-sectional postal survey design to secure data on people's experiences of the ED, asking them, amongst other things, why they did not wait. The study sample consisted of 642 people. 489 people were sent postal surveys which resulted in a response rate of 18% (n = 92). Data was analysed and compared using a combination of quantitative and qualitative techniques, using SPSS© and MS Excel© statistics software, elements of operations research (field observation) and content analysis. Subjective data was illuminated and extended by qualitative methods, namely interpretative and descriptive content analysis and an abstract conceptualisation of the themes generated is offered. Regional Ethics Committee approval was sought and granted prior to this investigation commencing. The results indicate that the majority of DNWs occur during daylight hours. The mean age of those who DNW was 27 years. They tended to be male. The greatest proportion of the DNW population analysed lived locally and waited a mean time of 112 minutes before choosing to leave. All Australasian Triage Scale categories (except ATS 1) demonstrated examples of those who took a DNW discharge. The most common complaints people presented with were ones they had endured for more than 12 hours and were sometimes days old. A high proportion of people reported that they received definitive treatment within 12 -24 hours following their departure from the ED. Common themes identified as reasons people chose to leave the ED related to their perception of action, perception of their illness and environment. Additional themes extracted from the data that influenced people's decisions to leave concerned their perceptions of staff communication/behaviour; systems processes; feelings of abandonment; other commitments and waiting time.
Emergency medical services, Hospitals, Emergency nursing, Emergency services -- Utilization, New Zealand