Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department

Kim, Julie J; Kwok, Edmund; Cook, O.; Calder, Lisa A.

doi:10.5811/westjem.2018.9.39369

Cited by 12 publications

(13 citation statements)

References 21 publications

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“…EDs in Ontario and British Columbia were compared on flow measures for adults and children but did not consider frequent users of EDs [25]. Other studies have examined a single ED or jurisdiction to describe [26,27] or compare [28][29][30] frequent users to other groups. In our study, the Ontario groups had higher acuity than the Alberta groups.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, discharged HSUs in Alberta had about the same mean LOS as discharged controls whereas discharged HSUs in Ontario had a mean LOS about 12 min longer than discharged controls. A study in an urban ED in Ottawa, Ontario showed that 261 highly frequent ED users (patients in the 99th percentile during 2014) with 3164 presentations had a median LOS of 5.2 h (Q1, Q3 3.1, 8.7) [26] and a study in a Singapore ED showed that 243 frequent users (≥4 presentations in 2015) with 1705 presentations had a median LOS of 2h54min (Q1, Q3 1h42min, 5 h) [27] but neither study compare this measure to non-frequent users. These highly frequent ED users had longer median LOS than either of the HSU groups in our study and Ontario HSUs had about the same median as the Singapore frequent users.…”

Section: Discussionmentioning

confidence: 99%

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Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Chen

Fielding

et al. 2020

BMC Health Serv Res

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Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Chen

Fielding

et al. 2020

BMC Health Serv Res

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“…In Canada, EDs are the focal point of discussion for many health-care professionals and policy makers, as these departments frequently operate above capacity. ( 1 ) Current literature has shown that a small group of ED patients contribute an disproportionate number of visits, ( 2 – 4 ) with older adults identified as a distinct cohort of complex patients at-risk for frequent visitation. ( 5 – 8 ) Older adults contribute a higher proportion of ED visits than younger persons and are more likely to visit for an urgent reason, resulting in hospital admission.…”

Section: Introductionmentioning

confidence: 99%

Older Emergency Department Patients: Does Baseline Care Status Matter?

et al. 2020

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Background Little is known about the prognostic differences between older emergency department (ED) patients who present with different formal support requirements in the community. We set out to describe and compare the patient profiles and patterns of health service use among three older ED cohorts: home care clients, nursing home residents and those receiving no formal support. Methods We conducted a secondary analysis of the Canadian cohort from the interRAI multinational ED study. Data were collected using interRAI ED contact assessment on patients 75 years of age and older (n = 2,274), in eight ED sites across Canada. A series of descriptive statistics were reported. Adjusted associations were determined using logistic regression. Results Older adults receiving no formal support services were most stable. However, they were most likely to be hospitalized. Older home care clients were most likely to report depressive symptoms and distressed caregivers. They also had the greatest odds of frequent ED visitation post-discharge (OR=1.9; 95% CI=1.39–2.59). Older adults transferred from a nursing home were the frailest but had the lowest odds of hospital admission (OR=0.14; 95% CI=0.09–0.23). Conclusion We demonstrated the importance of inquiring about community-based formal support services and provide data to support decision-making in the ED.

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“…In contrast, multimorbid repeated ED patients did not have more hospital admissions. Another novel finding in our analysis is that multimorbid frequent ED users presented less often during night shifts whereas recurrent ED users were more common during evening and night shifts [17,43]. One reason for that difference is that multimorbid frequent ED visitors may use the ED as a GP practice and therefore present less often during night shifts.…”

Section: Discussionmentioning

confidence: 95%

Recurrent Emergency Department Users: Two Categories with Different Risk Profiles

Slankamenac¹,

Zehnder²,

Langner³

et al. 2019

JCM

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Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Repeated ED users had more ED visits (p < 0.001) and needed more hospital admissions (p < 0.010) compared to frequent ED users. Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases (p < 0.001) and mental disorders (p < 0.001). In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled (p = 0.001), had an increased Charlson co-morbidity index (p = 0.004) or suffering from rheumatic diseases (p < 0.001). A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services.

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Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department

Cited by 12 publications

References 21 publications

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Older Emergency Department Patients: Does Baseline Care Status Matter?

Recurrent Emergency Department Users: Two Categories with Different Risk Profiles

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