Treatment of the unknown patient: insights from acute stroke

Emergency nurses' experience in caring for unidentified patients: A qualitative study

OBJECTIVE

To describe and analyse emergency nurses' experiences of caring for unidentified patients, and to provide a basis for constructing processes and standards of care for unidentified patients in the emergency department.

METHODS

This study is a descriptive phenomenological research that utilized purposive sampling. Sixteen emergency department nurses, who cared for unidentified patients between June and September 2023, were selected for semi-structured face-to-face interviews. Data were analyzed using Colaizzi's 7-step method to identify and refine themes.

RESULTS

Three themes were distilled: (1) increased workload, (2) increased mental stress at work, and (3) material needs and external environmental support.

CONCLUSION

Emergency nurses have more complex negative emotional experiences when dealing with unidentified patients and want more external support to cope with such patients. Hospital administrators should pay full attention to nurses' caregiving experiences and provide positive interventions.

Unidentified patients in the emergency department: a historical cohort study

OBJECTIVES

To characterize unidentified patients presenting to a single, urban emergency department (ED) in Canada. We report their demographics, ED course, post-ED discharge outcomes, and mode of identification.

METHODS

We performed a retrospective chart review using descriptive analyses to assess unidentified patients admitted to Royal University Hospital and St. Paul's Hospital EDs between May 1, 2018, and April 30, 2019, in Saskatoon, Saskatchewan, Canada. We assessed demographic data, clinical presentation, mode of identification, discharge information, and major clinical outcomes.

RESULTS

Unidentified patients were disproportionately male (64.9%), and mostly presented as Canadian Triage and Acuity Scale (CTAS) 1 (41.6%) and CTAS 2 (44.2%). Most patients arrived via emergency medical services (80.7%). The most common presenting complaints were substance misuse (33.3%) and trauma (24.6%). The average ED length of stay was 8.7 h (SD 18.6). Many patients received an inpatient consult (58.8%), and 22.3% received support services (e.g., social work). The 30-day mortality of all patients was 13.2%. Of those patients who survived to ED discharge, common dispositions included: home (36.0%), police services (3.5%), or emergency shelters (3.5%). Four (3.5%) patients returned to the hospital unidentified within the study period, and 6.7% of patients discharged from the ED returned within 48 hours.

CONCLUSION

Unidentified patients are a high-needs demographic that present mostly with substance misuse or trauma. Repeat ED attendance, sometimes as unidentified patients again, calls for initiatives that facilitate prompt identification, better discharge planning, and linkage to social supports.