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Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department

Published online by Cambridge University Press:  04 March 2015

Jessica Moe ,
Allan L. Bailey ,
Ryan Oland ,
Linda Levesque  and
Heather Murray
Jessica Moe*
Affiliation:
RCPSC EmergencyMedicine Residency Program, University of Alberta, Edmonton, AB
Allan L. Bailey
Affiliation:
WestView Physician Collaborative and WestViewPrimary Care Network; Department of Family Medicine, University of Alberta
Ryan Oland
Affiliation:
WestView Health Centre, WestView Physician Collaborative and WestView Primary Care Network; Department of Emergency Medicine, University of Alberta, Edmonton, AB
Linda Levesque
Affiliation:
Department of Community Health and Epidemiology, Queen's University, Kingston, ON
Heather Murray
Affiliation:
Department of Emergency Medicine and Department of Community Health and Epidemiology, Queen's University, Kingston, ON
*
RCPSC Emergency Medicine Residency Program, University of Alberta, 750 University Terrace, 8303 - 112 Street, Edmonton, AB T6G 2T4; jessica.moe@gmail.com

Abstract

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Introduction:

Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED.

Methods:

We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories.

Results:

The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users.

Conclusions:

We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.

Keywords

emergency medical servicesemergency medicineemergency servicefrequent emergency department usershealth care costshealth care qualityaccessevaluationhealth services' needs and demandshospitaloveruse of health services
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 4 , July 2013 , pp. 214 - 226
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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