Characteristics of Occasional and Frequent Emergency Department Users

Zuckerman, Stephen; Shen, Yu‐Chu

doi:10.1097/01.mlr.0000108747.51198.41

Cited by 205 publications

(184 citation statements)

References 20 publications

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“…[1][2][3][4][5][6][7][8][9] Despite varying definitions, high-frequency ED users have been described together as typically poor, male, members of minority groups, chronically ill, socially isolated, and frequently presenting with psychiatric or substance abuse problems. 2,5,10,11 The literature suggests, however, that characteristics differ between frequent users with less than 20 visits per year and those with more than 20 visits. 12,13 Frequent ED use places an economic burden on the health care system and may also indicate that basic needs have gone unmet.…”

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confidence: 99%

Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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Background: Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits. Methods: Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit-demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay-were analyzed and compared to data from the entire ED population for the same period. Results: Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (p , 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (p , 0.05). Patients left without being seen in 15.8% of visits. Conclusions: High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.

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confidence: 99%

Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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“…Contrary to popular belief, these patients generally do not lack health insurance or a primary care physician. [20][21][22][23][24] Several studies have even found that a change in health insurance status is related to increased ED use. 20,25 With universal access to health care in Ontario, ED use should theoretically be equal throughout the population.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status of emergency department users in Ontario, 2003 to 2009

Tozer

Belanger

Moore

et al. 2014

CJEM

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Objective: Emergency department (ED) overcrowding in Canada is an ongoing problem resulting in prolonged wait times, service declines, increased patient suffering, and adverse patient outcomes. We explored the relationship between socioeconomic status (SES) and ED use in Canada's universal health care system to improve our understanding of the nature of ED users to both improve health care to the most deprived populations and reduce ED patient input. Methods: This retrospective study took information from the National Ambulatory Care Reporting System (NACRS) database for all ED visits in Ontario between April 1, 2003, and March 31, 2010. As there is no direct measure of SES available from ED visit records, a proxy measure of SES was used, namely a deprivation index (DI) developed from material and social factors from the 2006 Canadian census using the patient's residential neighbourhood. DI scores were assigned to ED visit records using Statistics Canada's Postal Code Conversion File, which links postal and census geography. Results: A total of 36,765,189 visits occurred during the study period. A cross-province trend was found wherein the most deprived population used EDs disproportionately more than the least deprived population (relative risk: 1.971 95% confidence interval 1.969-1.973, p , 0.0001). This trend was stable across the entire study period, although the divergence is attenuating. Conclusion: Social determinants of health clearly impact ED use patterns. People of the lowest SES use ED services disproportionately more than other socioeconomic groups. Focused health system planning and policy development directed at optimizing health services for the lowest SES populations are essential to changing ED use patterns and may be one method of decreasing ED overcrowding. RÉ SUMÉObjectif: L'encombrement des services des urgences (SU) au Canada est un problè me chronique, qui a pour effets de prolonger les dé lais d'attente, de diminuer la qualité des services, d'accroître les souffrances des patients et d'alté rer l'é volution de leur é tat de santé . Nous avons donc examiné la relation entre le statut socioé conomique (SSE) des usagers et l'utilisation des SU dans le cadre du systè me de soins de santé universels au Canada afin de dé gager les caracté ristiques de ces usagers, et ce, dans l'optique d'amé liorer la qualité des soins donné s aux populations les plus dé favorisé es et de diminuer le nombre de patients dans les SU. Ré sultats: Au total, 36 765 189 consultations ont é té dé nombré es durant la pé riode à l'é tude. Une tendance gé né rale s'est dé gagé e de tous les SU de la province: les populations les plus dé favorisé es ont eu recours aux SU de maniè re disproportionné e par rapport aux populations les moins dé favorisé es (risque relatif: 1.971; intervalle de confiance à 95%: 1.969-1.973; p , 0.0001). La tendance s'est ré vé lé e stable tout le long de la pé riode à l'é tude, bien que l'é cart soit en voie de diminution maintenant. Conclusions: Les dé terminants sociaux de la santé ...

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“…First, there is conflicting evidence about whether it is primary care service characteristics or patient characteristics that determine emergency department use. In North America, some studies have found that emergency department users are more likely to be nonwhite, poor, and less educated, [7][8][9] although other studies have shown that a focus on systems issues may impact on emergency department use. 10,11 Second, much of the research that links primary care supply factors to hospital attendances is based in the North American context and not necessarily applicable to the NHS.…”

Section: Introductionmentioning

confidence: 99%

Primary care access and its relationship with emergency department utilisation: an observational, cross-sectional, ecological study

Harris¹,

Patel²,

Bowen³

2011

Br J Gen Pract

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BackgroundRecent health service policies in the UK have focused on improving primary care access in order to reduce the use of costly emergency department services, even though the relationship between the two is based on weak or little evidence. Research is required to establish whether improving primary care access can influence emergency department attendance. AimTo ascertain whether a relationship exists between the degree of access to GP practices and avoidable emergency department attendances in an inner-London primary care trust (PCT). Design and settingObservational, cross-sectional ecological study in 68 general practices in Brent Primary Care Trust, north London, UK. MethodGP practices were used as the unit of analysis and avoidable emergency department attendance as the dependent variable. Routinely collected data from GP practices, Hospital Episode Statistics, and census data for the period covering 2007-2009 were used across three broad domains: GP access characteristics, population characteristics, and health status aggregated to the level of the GP practice. Multiple linear regression was used to ascertain which variables account for the variation in emergency department attendance experienced by patients registered to each GP practice. ResultsNone of the GP access variables accounted for the variation in emergency department attendance. The only variable that explained this variance was the Index of Multiple Deprivation (IMD). For every unit increase in IMD score of the GP practice, there would be an increase of 6.13 (95% CI = 4.56, 7.70) per 1000 patients per year in emergency department attendances. This accounted for 47.9% of the variance in emergency department attendances in Brent. ConclusionAvoidable emergency department attendance appears to be mostly driven by underlying deprivation rather than by the degree of access to primary care.

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Characteristics of Occasional and Frequent Emergency Department Users

Cited by 205 publications

References 20 publications

Frequent users of an inner-city emergency department

Frequent users of an inner-city emergency department

Socioeconomic status of emergency department users in Ontario, 2003 to 2009

Primary care access and its relationship with emergency department utilisation: an observational, cross-sectional, ecological study

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