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10 Cards in this Set

  • Front
  • Back
True/false
"Did Not Wait" represents:
1. Failure to provide timely care
2. 10% of all ED presentations
3. Even spread across demographics
4. High risk patients
1. True
2. False. (1-5% national average)
3. False. Lower socio-economic patients more likely
4. False. Mostly cat 4/5
(Dunn p210)
Which of these known Factors associated with "Did not wait" DNW is the MOST common reason for Leaving Without being Seen (LWBS):
1. After hours presentation
2. Parent's with children
3. Lower ATS scale
4. Longer waiting time,
5. Overcrowding
Longer waiting time.

(Dunn p210)
Which of these CONSEQUENCES of "Did Not Wait" patients is false?
1. Most patients do not get medical followup
2. Adverse outcomes are rare
3. High risk patients do have adverse outcomes.
4. Patients who leave before being seen sometimes complain and litigate
1. 2/3 of pts who Did Not Wait get medical followup, mostly outside of hospital setting. 5% represent to ED.

(Dunn p210)
How to assess risk in "Did Not Wait" patients

Important information recorded for ALL patients who attend.

(Dunn p210)
1. GP/referral letter
2. Triage category
3. Symptoms/presenting complaint
4. Recorded obs
When pt's threaten "Did Not Wait" , staff should enquire to and record all communications, especially.

(Dunn p210)
escalating symptoms
resolved symptoms
increased parental concern
reassurance
escalating dissatisfaction
When managing risk of threatened "Did Not Wait", staff should

(Dunn p210)
Involve family
encourage to stay
ensure comfort/symptom relief
notify senior staff
notify/involve referring service
Department and other pt safety is always important but escalation or increased priority should be considered in SOME patients who threaten to "Did Not Wait".....

High risk situations listed in Dunn (p210)
chest pain
• head injury
• headache
• fever or other abnormal vital signs
• paediatric patient
• elderly patient
• pregnancy
• GP concern – referral letter / telephone call
• impaired patient judgement
• alcohol and drug intoxication
• psychosis or other psychiatric conditions
• involuntary restraint may occasionally be appropriate if high risk of significant harm is substantial and patient judgement thought to be impaired
True/false
Every case of "Did Not Wait" should have followup arranged with phone-call/GP contact.
False. Most cases are low risk, but individuals with high risk should be contacted.

(Dunn p210)
Which of the following techniques for reducing rates of "Did Not Wait" is most important?:

• shorter ED waiting times
• ensure accurate triage allocation
• also linked to patient reassurance
• adequate staffing to attend patients in waiting room
• careful attention to patients in waiting room as waiting time extends
- provide comfort measures
- regular communication
- educate waiting patients about triage proces
• shorter ED waiting times
• shorter ED waiting times
• shorter ED waiting times

(Dunn p210)
Legal issues with Did Not Wait patients

(Dunn p210)
-Documentation is important
-Attempts to recall/escalate high risk patients and DOCUMENT
-patients psychiatric/cognitive disturbance may need to be held as "duty of care"