Frequent attenders at emergency departments: a linked‐data population study of adult patients

Abstract

Objectives: To examine the characteristics of adult patient attendances to emergency departments (EDs) in Perth hospitals by patients’ frequency of attendance. Design, setting and participants: A linked‐data population study of adults (aged ≥ 15 years) attending all nine Perth hospital EDs between 1 July 2000 and 31 December 2006. Main outcome measures: Proportion of frequent attenders (FAs; those attending five or more times annually); and demographic characteristics, mode of arrival at the ED, disposition (admission, transfer, discharge or death), urgency and clinical conditions by frequency of attendance. Results: There was a mean of 1.5 attendances per individual per year, resulting in 1 583 924 attendances by 663 309 individuals over the 6.5 years of the study. Most patients (97.6%) attended Perth EDs fewer than five times a year. The more frequently patients attended, the more likely they were to be male, middle‐aged and late‐middle‐aged, have self‐referred, have mental and behavioural disorders and alcohol intoxication, to not wait to be assessed, and to arrive by ambulance. The groups of patients attending between 5–9 and 10–19 times per year (97.4% of FAs) had more urgent conditions, more circulatory system disease and higher admission rates than all other patients. Conclusion: Most FAs at Perth EDs present fewer than 20 times a year and have more serious and urgent illness than other patients, more often requiring inpatient services. A very small minority of patients (around 100 patients/year) attends 20 or more times a year, many with mental and behavioural disorders and alcohol intoxication not requiring hospital admission.

Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review

“…Authors of primary studies were mainly from the USA 4 15–17 26 28 29 31–34 36 37 39 42. Other countries represented in this pool of studies were Canada,3 19 22 23 the UK,20 30 43 Australia,21 27 Finland,40 41 Ireland,18 38 Sweden24 25 and Portugal 35…”

“…The majority of studies were conducted in urban15–18 23 26 27 29–34 36–42 or inner city/suburban EDs 3 21 24 25 28 35 43. Three studies included ED data from larger (provincial/state) catchment areas,4 19 22 whereas one study served both urban and rural areas 20.…”

“…The most common definition of frequent ED users considered patients who visited the ED four or more times in 1 year 17 18 24–26 28 30 31 35 38. Other definitions considered patients with at least 2,39 3,33 34 40 41 5,3 4 27 29 32 6,15 37 7,43 10,20 36 12,16 19 15,23 1822 or 2039 ED visits in 1 year to be frequent ED users. Additional definitions of frequent ED users included two or more visits in 1 month,31 four visits in 3 months37 and >4 visits in 6 months 42.…”

“…Of six cohort studies reporting mortality, five were of moderate methodological quality4 22 24 27 39 and one was of poor methodological quality 36. The one cross-sectional study reporting mortality was of moderate methodological quality 42.…”

“…Six cohort studies4 22 24 27 36 39 compared mortality outcomes of frequent ED users versus non-frequent ED users. The odds of frequent ED users dying ranged from no difference (OR 1.02; 95% CI 0.77 to 1.42)39 to three times higher (OR 3.11; 95% CI 2.75 to 3.52)22 compared with non-frequent ED users (figure 4).…”