Profiling frequent attenders at an inner city emergency department

Abstract

Background

Emergency department (ED) frequent attenders (FAs) have a higher rate of adverse outcomes compared to infrequent attenders.

Aims

The primary aim was to describe the prevalence of FAs at an inner city ED. A subgroup analysis was undertaken for high and very high FAs to establish demographics and other factors which might cause them to attend frequently.

Methods

A retrospective review of all patients who attended the ED at Mercy University Hospital (MUH), Cork, during 2016 was undertaken. Patients were classified as either infrequent attenders (1–2 attendances/year), frequent attenders (3–12 attendances/year), high frequent attenders (HFA, 13–29 attendances/year), or very high frequent attenders (VHFA, > 30 attendances/year).

Results

During 2016, a total of 21,920 patients presented 33,152 times. Overall, 90.2% (n = 19,761) were infrequent attenders, whilst 9.6% (n = 2115) were FAs. A further 36 patients (0.16%) were HFAs and eight patients (0.04%) were classified as VHFAs. Almost 10% of patients attended the ED three or more times, accounting for 29% of overall ED attendances. The HFA and VHFA cohorts were predominantly male (79.5%, n = 35) with an average age of 49.6 years. They were found to have multiple medical comorbidities, complex psychosocial problems, and a mortality rate of 11.3% over a 2-year period.

Conclusions

This retrospective review is the most detailed assessment of Irish FAs undertaken to date. Further studies are required to examine the Irish hospitals most at need of Case Management Strategy Programmes which we postulate could minimise the risk of adverse outcomes for these patients and improve overall ED efficiency.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Lacalle E, Rabin E (2010) Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 56(1):42–48. https://doi.org/10.1016/j.annemergmed.2010.01.032

    Article  PubMed  Google Scholar 

  2. 2.

    Gunnarsdottir OS, Rafnsson V (2006) Mortality of the users of a hospital emergency department. Emerg Med J 23:269–274

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Moe J, Kirkland S, Ospina MB, Campbell S, Long R, Davidson A, Duke P, Tamura T, Trahan L, Rowe BH (2016) Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review. Emerg Med J 33:230–236

    Article  PubMed  Google Scholar 

  4. 4.

    Mcgovern EJ, Bolger J, Courtney D, Khan W, Khan I, Horan J et al (2016) Can “hot spotting” prove to be a useful tool to identify disproportionate ED use in the rural general hospital setting? Ir Med J 109(8):452

    CAS  PubMed  Google Scholar 

  5. 5.

    Royal College of Emergency Medicine (2017) Best practice guideline: frequent attenders in the emergency. https://www.rcem.ac.uk//docs/RCEM%20Guidance/Guideline%20-%20Frequent%20Attenders%20in%20the%20ED%20(Aug%202017).pdf. Accessed 2 Feb 2018

  6. 6.

    Locker TE, Baston S, Mason SM, Nicholl J (2007) Defining frequent use of an urban emergency department. Emerg Med J 24:398–402

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Bieler G, Paroz S, Faouzi M, Trueb L, Vaucher P, Althaus F, Daeppen JB, Bodenmann P (2012) Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Acad Emerg Med 19:63–68

    Article  PubMed  Google Scholar 

  8. 8.

    Murphy AW, Leonard C, Plunkett PK, Brazier H, Conroy R, Lynam F, Bury G (1999) Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period. J Accid Emerg Med 16:425–427

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Byrne M, Murphy AW, Mcgee HM, Mod BA, Murray A (2003) Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med 41(3):309–318

    Article  Google Scholar 

  10. 10.

    Ramasubbu B, Donnelly A, Moughty A (2016) Profile of frequent attenders to a Dublin inner city emergency department. Ir Med J 109(4):389

    CAS  PubMed  Google Scholar 

  11. 11.

    Ramasubbu B, Lee B, Collins N (2015) Re-attenders to the emergency department of a major urban hospital serving a population of 290,000. Ir Med J 108(1):18–19

    Google Scholar 

  12. 12.

    Nelson K, Connor M, Wensley C, Moss C, Pack M, Hussey T (2011) Review article: people who present on multiple occasions to emergency departments. Emerg Med Australas 23:532–540

    Article  PubMed  Google Scholar 

  13. 13.

    Ní Cheallaigh C, Cullivan S, Sears J, Lawlee AM, Browne J, Kieran J, Segurado R, O’Carroll A, O’Reilly F, Creagh D, Bergin C, Kenny RA, Byrne D (2017) Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open 7:e016420

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Hardie TL, Polek C, Wheeler E, Mccamant K, Dixson M, Gailey R et al (2015) Characterising emergency department high-frequency users in a rural hospital. Emerg Med J 32:21–25

    Article  PubMed  Google Scholar 

  15. 15.

    Vinton DT, Capp R, Rooks SP, Abbott JT, Ginde AA (2014) Frequent users of US emergency departments: characteristics and opportunities for intervention. Emerg Med J 31:526–532

    Article  PubMed  Google Scholar 

  16. 16.

    Skinner J, Carter L, Haxton C (2009) Case management of patients who frequently present to a Scottish emergency department. Emerg Med J 26:103–105

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Mandelberg JH, Kuhn RE, Kohn MA (2000) Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med 7(6):637–646

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Irish Committee for Emergency Medicine Training, Irish Association for Emergency Medicine, Health Service Executive (2012) The National Emergency Medicine Programme. https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/the-national-emergency-medicine-programme.pdf. Accessed 7 Mar 2018

  19. 19.

    Soril LJJ, Leggett LE, Lorenzetti DL, Noseworthy TW (2015) Reducing frequent visits to the emergency department: a systematic review of interventions. PLoS One 10(4)

  20. 20.

    Newton A, Sarker SJ, Parfitt A, Henderson K, Jaye P, Drake N (2011) Individual care plans can reduce hospital admission rate for patients who frequently attend the emergency department. Emerg Med J 28:654–658

    Article  PubMed  Google Scholar 

  21. 21.

    Ng J, Hayhurst C (2016) Best Bets - the effectiveness of case management at reducing the number of emergency department frequent attenders. BestBets Best Evidence Topics. http://www.bestbets.org/bets/bet.php?id=2858. Accessed 3 Apr 2018

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Susan Uí Bhroin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Uí Bhroin, S., Kinahan, J. & Murphy, A. Profiling frequent attenders at an inner city emergency department. Ir J Med Sci 188, 1013–1019 (2019). https://doi.org/10.1007/s11845-019-01964-2

Download citation

Keywords

  • Emergency medicine
  • Psychiatry
  • Vulnerable patients