Frequent users of an inner-city emergency department

Abstract

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.

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.…”

“…Three studies included ED data from larger (provincial/state) catchment areas,4 19 22 whereas one study served both urban and rural areas 20. Twelve studies were reportedly conducted in general EDs from academic centres,16–18 21 23 29 31 32 34 36 39 42 and four studies were conducted in emergency psychiatric services 26 37 40 41. Overall, studies included patients with all types of medical conditions; however, some studies restricted the inclusion to special populations of psychiatric patients,26 37 40 41 substance users,33 homeless patients28 and individuals >65 years of age 38 42…”

“…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.…”

“…Sixteen studies3 4 15–17 20 21 23 26 27 29 30 32 35 37 39 reported admission outcomes based on the number of visits attributed to frequent or non-frequent users that resulted in hospital admission during the study period (ie, visit numbers as a denominator). Four of these studies were excluded from the forest plot (figure 5) as they did not report denominators (ie, number of visits) to calculate ORs for hospital admissions per visits in the two groups 3 17 20 37.…”