Patterns of access for primary health care have placed additional strain on emergency departments (EDs). Issues related to these patterns were explored in this ex post facto study. Johnson's Behavioral Systems Model (1968) provided the conceptual framework. The following research questions were explored; What is the incidence of ED patients leaving without being seen by a health care provider? What are the demographic characteristics of ED patients who leave without being seen? How do demographic characteristics of ED patients who leave compare to those who are seen by a health care provider? And what are the reasons given by patients for leaving without being seen by a health care provider? Data were obtained from a chart review and a voluntarily completed telephone interview. The sample consisted of patients (N = 671) who presented to the ED during the peak activity hours between 7:00 a.m. and 11:00 p.m. over a 14-day period and received a nonurgent classification at the time of triage. The sample was subdivided into two groups. Group A (n = 647) represented all patients who stayed to be treated by a health care provider and Group B (n = 24) represented all patients who left the ED without being seen by a health care provider. Seventy percent of the patients were nonurgent; of these, 4% left without being seen. The average length of stay prior to leaving was 1.6 hours, and the mean length of time between onset of symptoms and request for treatment was 4.4 days. The majority of the patients who left without being seen by a health care provider were single, black males who were unemployed and underinsured, whereas the largest percent of ED patients who stayed for treatment were single, black, unemployed, and underinsured women. The most frequently given reason for leaving the ED without treatment was having to wait too long. Recommendations for future research include comparisons of triage classification and actual patient acuity at completion of treatment, physician acceptance of the NP role, and finally the impact on access to care after implementation of an NP staffed ED fast-track.


Master of Science in Nursing (MSN)


Graduate Nursing

Degree Date


Publication Number


First Advisor

Dr. Linda Sullivan

Second Advisor

Dr. Mary Patricia Curtis

Third Advisor

Lenora Griffin

Document Type


Included in

Nursing Commons