Frequent attenders at Christchurch Hospital's Emergency Department: a 4-year study of attendance patterns.N Z Med J. 2004 May 07; 117(1193):U871.NZ
To describe the pattern of Emergency Department (ED) use by a cohort of adult frequent attenders over a 4-year period.
A descriptive retrospective cohort study was performed of frequent attenders, identified as having 10 or more presentations to the ED, from 1 January 1997 to 31 December 1997. Diagnoses were assigned from hospital records. ED visits for the subsequent 3 years were recorded.
Seventy-seven patients were identified. They made 1127 (1.7%) of the 65,007 ED visits in 1997. Thirty-five patients (45%) had a medical problem, 22 (29%) had a psychiatric problem, and 20 (26%) had a diagnosis of substance abuse as the main reason for their ED visits. Twenty-seven patients (35%) had a diagnosis in more than one category. Of the original 77 patients, 46 (60%) were frequent attenders only in the index year. In the final study year, 13 patients (17%) remained frequent attenders, 37 (48%) presented less than 10 times, and 27 (35%) made zero visits. Seven patients (9%) remained frequent attenders in all 4 years. Ten patients (13%) died. Five (6%) were identified as having left the area. In the final year of the study, there were, by the same criteria, a total of 76 frequent attenders to the ED. Only 13 (17%) of these attenders were from the original cohort.
Frequent attenders to the ED are not, as commonly assumed, a constant population. The majority of patients change their frequency of attendance over time. Those patients who remain high users have a higher incidence of psychiatric illness and substance abuse. To initiate management intervention, ED records must be regularly monitored to identify the constant stream of new frequent attenders.