[Children who leave the Emergency Department: missing opportunities?].

INTRODUCTION Children who leave the Emergency Department may be at risk for preventable health problems related to the lack of timely assessment. OBJECTIVE The aim of this study was to evaluate and characterize the cases of children leaving our Emergency Department and to determine their clinical outcome. MATERIAL AND METHODS A retrospective and descriptive review of the patient's medical records was conducted. All children leaving the Emergency Department of Hospital de São Bernardo between January 1 and December 31, 2012, were included in the study. RESULTS A total of 538 children abandoned the Emergency Department (1.35 % of all admissions). The majority (89.5%) had no criteria for urgent assessment and abandoned before medical observation (82.7%). The percentage of leaving was higher in the months of December, January and February (64%), on Tuesday (19.3%) and in the afternoon shift (60.8%). These periods coincided with the peak inflow of patients to the Emergency Department. The waiting time for medical observation was in most cases (94.4%) appropriate to the clinical severity. Six patients returned within 72 hours, 2 requiring hospitalization. DISCUSSION The percentage of patients that walked-out from the Emergency Department was within the excepted range. A non-urgent triage level and prolonged waiting times were predisposing factors to abandonment. CONCLUSION Overcrowding of the Emergency Department with children with non-urgent problems, that increase waiting times, can lead to abandonment with unfavorable outcome, which in our series occurred in only 2 cases.