Return Visits, Admission, and Mortality After Leaving Without Being Seen Among Emergency Department Patients With Behavioral Health Presentations
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Importance
Patients with behavioral health presentations leave the emergency department (ED) before evaluation more often than other patients, but outcomes after leaving without being seen (LWBS) have not been described in this population.
Objective
To compare return visits, admission, and mortality after LWBS vs completed care among behavioral health ED episodes.
Design, Setting, and Participants
This retrospective episode-level cohort study used a multisystem deidentified electronic health record database of US health systems (data snapshot June 4, 2026). Participants were patients of all ages with an ED visit and same-day behavioral health diagnosis. Index visits (recorded January 26, 2001 to April 13, 2025) each opened a 30-day episode window; in-window were counted as outcomes, and patients could contribute episodes to either group. Data were analyzed in October 2026.
Exposure
LWBS (diagnosis code Z53.21 on a date with an ED encounter) vs completed care ending in discharge home.
Main Outcomes and Measures
The primary outcome was ED return visit within 7 days. Secondary outcomes were return visit within 3 and 30 days; admission on day 0, on days 1-7 (principal measure), and within 30 days; and all-cause death within 7 and 30 days, assessed among episodes from 2017 through 2023 using a verified death-record definition.
Results
The analysis included 1,305,812 episodes (12,248 LWBS; 1,293,564 completed care) from 525,490 patients; 666,930 episodes (51.1%) involved female patients and 66,733 (5.1%) involved patients younger than 18 years. Return visit within 7 days followed 24.5% of LWBS episodes vs 13.2% of completed-care episodes (risk ratio [RR], 1.86; 95% CI, 1.81-1.92), and admission on days 1-7 followed 17.1% vs 3.9% (RR, 4.41; 95% CI, 4.24-4.59). Among 2017-2023 episodes, 30-day mortality was 0.69% (70 of 10,141) after LWBS vs 0.32% (2,426 of 756,140) after completed care (RR, 2.15; 95% CI, 1.70-2.73). Results were similar under alternative episode definitions.
Conclusions and Relevance
Among patients with behavioral health ED presentations, LWBS was followed by higher rates of return visits, admission, and short-term mortality than completed care. These unadjusted findings describe outcome burden, not causal effects, and highlight patients who leave as a target for rapid follow-up.
Key Points
Question
Among patients with behavioral health emergency department presentations, are return visits, admission, and death more common after leaving without being seen than after completed care?
Findings
In this cohort study of 1,305,812 behavioral health emergency department episodes, 7-day return visits followed 24.5% of episodes in which the patient left without being seen vs 13.2% after completed care; admission on days 1-7 (17.1% vs 3.9%) and 30-day mortality (0.69% vs 0.32%) were also higher.
Meaning
Behavioral health patients who leave without being seen carry a greater short-term outcome burden, and the first days after departure are a practical window for outreach.
