Uncompleted emergency department care and against-medical-advice discharge represent relevant medical problems with impact on patient safety and potential medicolegal and socioeconomic consequences. They may also indicate structural or procedural problems in the emergency department (ED) relating to patient management and flow. While patients with neurological complaints frequently leave the ED against medical advice or without being seen, no dedicated analysis of this group of patients aiming at the identification of characteristics associated with irregular ED discharge has been performed so far. A chart review was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017 for neurological evaluation. Demographics, mode of presentation, process times, presenting symptoms and diagnosis were recorded. Patients leaving against medical advice after an informed consent discussion and signing of documentation (DAMA) or leaving prematurely without notifying ED staff (PL) were compared to the total of patients who were admitted or discharged (non-DAMA/PL). Of all patients presenting with neurological symptoms or complaints, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p < .001), and they were more frequently self-presenting (p < 0.001). Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the duration of door-to-doctor time. Younger age, self-presenting mode of presentation and presentation with headache, seizures or sensory deficits are associated with premature leave or against-medical-advice discharge of patients with neurological complaints from the ED, and long waiting times were given as the major reason for leaving the ED. Increasing ED staff’s awareness of these factors and the optimization of pre-hospital assessment and demand management, thereby positively impacting on patient flow and ED process times, may help to prevent irregular discharges from the ED.

中文翻译：

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急诊科未完成护理和出院，对神经系统疾病患者的医疗建议：图表审查

急诊科的护理不完善和医疗建议的出具不当，代表了相关的医学问题，对患者的安全产生了影响，并可能造成法医学和社会经济后果。它们还可能指示急诊科（ED）中与患者管理和流程有关的结构或程序问题。尽管有神经系统疾病的患者经常在不遵医嘱或不被看护的情况下离开急诊室，但迄今为止，尚未针对该组患者进行专门的分析，以鉴定与不规则急诊室放电相关的特征。在2017年1月至12月之间向德国跨学科急诊科呈报的所有神经系统疾病患者进行了图表审查，以进行神经系统评估。受众特征，演示方式，处理时间，记录症状和诊断。将经过知情同意讨论并签署文件（DAMA）后未就医的患者或未事先通知ED人员（PL）而过早离开的患者与入院或出院的患者总数（非DAMA / PL）进行了比较。在所有出现神经系统症状或不适的患者中，有3％的患者不服医嘱，有2.2％的患者过早离开。DAMA / PL患者较年轻（p <.001），他们更常出现自我症状（p <0.001）。头痛，癫痫发作和感觉障碍是DAMA / PL患者中最常见的症状，癫痫发作史中有56.1％的患者表现为癫痫病史。记录在案的最常见离开原因是上门医生的时间长短。年龄较小，自我呈现的方式和头痛，癫痫发作或感觉不足的呈现方式与急诊部神经病患者的早产假或反对医疗建议出院有关，并且较长的等待时间被认为是离开急诊部的主要原因。急诊人员对这些因素的意识增强，以及优化院前评估和需求管理，从而对患者流量和急诊流程时间产生积极影响，有助于防止急诊出院。