Public hospitals in general (and their emergency departments in particular) have long functioned as America's health care safety net for our urban poor. In this issue of The Journal, researchers at two California public hospitals present findings1,2 that challenge a fundamental assumption about emergency department care—that it will always be available in time of need. Both groups of researchers report a disturbing observation. In the face of growing hospital and emergency department overcrowding, substantial numbers of patients with serious problems are leaving emergency departments without being seen.
In contrast to previous studies,3-6 which determined that most patients who walk out of hospital emergency departments have minor or self-limited problems, these two studies documented a far more serious situation. According to self-reported measures of health status and objective nursing assessments, many of these patients had problems that required urgent treatment. Few left quickly,
Kellermann AL. Too Sick to Wait. JAMA. 1991;266(8):1123–1125. doi:10.1001/jama.1991.03470080093037
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