Frequent Attendees to the Emergency Department

Abstract

Objective: To determine the prevalence of frequent attendees to the emergency department (ED) and highlight their contribution to the overall visits. To describe, also, the nature of the patients' visits in terms of their demographical, clinical, and utilization characteristics. Methods: A retrospective cross-sectional survey was conducted on all patients presenting to the ED at the Queen Elizabeth Hospital in Barbados over a 12-month period. Patients were then divided into groups and compared for attendance trends. “Frequent attendees” are patients who visited the department five or more times in 1 year. Results: Frequent attendees represent 3.2% of the patient population and account for 15.8% of all visits. Visits ranged from 1–59 per patient during the year 2001. There were 6682 visits made by these patients. There was a slight male predominance; the “age of majority” was actually those aged < 21 years. Most patients visited with complaints due to asthma (21.4%), non-extremity trauma, musculoskeletal disorders, and gastrointestinal disorders, in descending order. Patients preferred to present between 8:00 a.m. and 8:00 p.m. and on Sundays and Mondays. Frequent attendees were more likely to arrive via ambulance and have a higher triage code, but less likely to be admitted. Discussion: Asthma is a dominant chronic condition among frequent ED users. Traumatic conditions are also of concern in patients who have high return rates. Recommendations for a curriculum should include chronic management training as well as teaching skills to impart continuous medical education on prevention of injuries to the public. In addition, a multidisciplinary approach to patients at risk for multiple return visits is essential, not primarily to reduce visits but to better meet patient needs.