Introduction: Did not wait (DNW) is a frequently cited Emergency Derpartment (ED) key performance indicator. Adverse
outcomes have been associated with patients that voluntarily leave before receiving medical treatment. We conducted a
network based observational study of consecutive DNW presentations. The study setting was a network of urban
Emergency Departments (5 local hospitals) at Western Sydney Local Health District (WSLHD) Australia receiving over
100,000 presentations per year.
Methods: Target group were patients who left ED, after being triaged, but without initiation of treatment. Inclusion criteria
at enrolled sites were (1) true DNW (defined by the state government KPI); (2) age ≥18 years. Prospective cohort study
of WSLHD with a primary outcome measure of reported 30-day all-cause mortality and secondary outcomes of
demographic characteristics and representation risk. For re-presenting patients who were subsequently admitted, a
manual review of electronic records and incident report systems based on a priori plan assessed each case for the length
of stay and adverse outcomes. Ethical approval was granted by the local Human Research Ethics Committee (HREC) (
Code1908-08) and the study adhered to Australian national research standards.
Results: A total of 1,326 patients were analysed, of which 1,118 (84.3%) were true DNW cases and aged ≥18. Of these
cases, triage category 4 patients accounted for 41.1%, 53.6% were aged 21-40 years, and 46.3% waited less than 2
hours. A total of 164 (14.7%) re-presented within a 72-hour period, of which 48 were admitted. From these, highest
admission causes were abdominal pain (25%) requiring Short Stay Unit or ward-based admission. A single patient died
within 30-days of their DNW visit but was actively palliated for malignancy prior to presentation.
Conclusion: We found that the majority of DNW patients presented with non-acute illnesses; many of which left 2 hour
after being triaged. While there were no deaths as a direct consequence of not waiting, a number of patients re-presented
within 72 hours and were admitted, suggesting significant pathology may be present amongst patients who DNW.
Disclosure of Interest: None Declared
Keywords: Did not wait, Emergency Department Length Of Stay (ED LOS), emergency departments