• Catherine A Marco, Morgan Bryant, Brock Landrum, Brenden Drerup, and Mitchell Weeman.
• Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States. Electronic address: Cmarco2@aol.com.
• Am J Emerg Med. 2021 Feb 1; 40: 115-119.

ObjectiveEmergency department (ED) patients may elect to refuse any aspect of medical care. They may leave prior to physician evaluation, elope during treatment, or leave against medical advice during treatment. This study was undertaken to identify patient perspectives and reasons for refusal of care.MethodsThis prospective study was conducted at an urban Level 1 Trauma Center. This study examined ED patients who left without being seen (LWBS), eloped during treatment, or left against medical advice during September to December 2018. This project included both chart review and a prospective patient survey.ResultsAmong 298 participants, the majority were female (54%). Most participants were White (61%) or African American (36%). Thirty-eight percent of participants left against medical advice, 23% eloped, and 39% left without being seen by a provider. When compared to the general ED population, patients who refused care were significantly younger (p < 0.001). When comparing by groups, patients who left AMA were significantly older than those who eloped or left without being seen (p < 0.001). Among 68 patients interviewed by telephone, the most common stated reasons for refusal of care included wait time (23%), unmet expectations (23%), and negative interactions with ED staff (15%).ConclusionED patients who refused care were significantly younger than the general ED population. Common reasons cited by patients for refusal of care included wait time, unmet expectations, and negative interactions with ED staff.Copyright © 2019 Elsevier Inc. All rights reserved.

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