Early departures from the emergency department in a high-volume tertiary center: the first report from Croatia

Aim To determine the characteristics of early emergency department (ED) departures, including patients leaving without being seen and leaving during treatment, in a large tertiary center in Croatia. Methods We retrospectively reviewed ED visits at University Hospital Center Split from July 12, 2023, to July 12, 2024. The study enrolled patients who had been triaged but left before physician evaluation or before completing diagnostic workup. Pediatric, gynecologic, psychiatric, and infectious disease ED visits were excluded because these specialties are managed separately. Data on demographics, Australasian Triage Scale category, referral type, specialty routing, seasonal/circadian patterns, and 48-hour return visits were extracted from the hospital information system. Results Among 110 547 patients visiting the ED, 1420 (1.3%) departed early. Their median age was 40 years (interquartile range 25-59); 55.6% were male. Most were low-acuity patients (category 4: 60%; category 5: 29%). Early departures peaked in August-September and between 2 pm and 10 pm daily (maximum at 7 pm). Self-referred patients accounted for 65% of early departures, and 26% had been routed to orthopedics/trauma specialists. Only 5% left during treatment. Within 48 hours, 20% returned to the ED and 12% required other hospital evaluations. Conclusion Early ED departure rate was low. The patients were mostly young, male, low-acuity, and self-referred with trauma-related conditions, presenting during tourist surges and evening hours. These findings underscore the need for dynamic staffing, enhanced triage communication, targeted patient education, and seasonal preparedness to sustain efficient ED performance.