Individual predictors of frequent emergency department use: a scoping review.

Maud-Christine Chouinard,Cynthia Krieg,Catherine Hudon,Isabelle Dufour

doi:10.1186/s12913-016-1852-1

Abstract

BackgroundA small proportion of patients use an excessively large amount of emergency care resources which often results in emergency department (ED) overcrowding, decreased quality of care and efficiency. There is a need to better identify these patients in order to target those who will benefit most from interventions adapted to their specific needs. We aimed to identify the predictive factors of short-term frequent use of ED (over a 1-year period) and chronic frequent use of ED (over a multiple-year period) and to highlight recurring characteristics in patients.MethodsA scoping review was performed of all relevant articles found in Medline published between 1979 and 2015 (Ovid). This scoping review included a total of 20 studies, of these, 16 articles focussed on frequent ED users and four others on chronic frequent ED users.ResultsA majority of articles confirm that patients who frequently visit the ED are persons of low socioeconomic status. Both frequent and chronic frequent ED users show high levels of health care use (other than the ED) and suffer from multiple physical and mental conditions.ConclusionsThis research highlights which individual factors predict frequent emergency department use. Further research is needed to better characterize and understand chronic frequent users as well as the health issues and unmet medical needs that lead to chronic frequent ED use.

Highlights

A small proportion of patients use an excessively large amount of emergency care resources which often results in emergency department (ED) overcrowding, decreased quality of care and efficiency
Identifying the research question Based on current knowledge found in an initial review of the literature, our primary research question was defined as follows: Which factors are predictive of frequent emergency department use? A secondary question was explored: Which factors predict chronic frequent emergency department use over a multiple-year period?
Twelve studies were from the USA [3, 4, 8, 9, 23, 33, 38,39,40,41], two were from Canada [11, 27], two were from Sweden [5, 7] and the four other studies were from Singapore [37], Switzerland [6], Taiwan [10] and Australia [42]

Summary

Introduction

A small proportion of patients use an excessively large amount of emergency care resources which often results in emergency department (ED) overcrowding, decreased quality of care and efficiency. A small proportion of patients utilize a disproportionately large amount of acute emergency care resources [1] They represent as little as 2.7 % [2] of patients attending the emergency department (ED), but make up to 67 % [3] of all ED visits over a given period of time (usually 1 year). Frequent ED visits represent substantial costs to the health care system [12,13,14] They decrease ED efficiency [15], contribute to ED overcrowding [16, 17] and can potentially impact services by redirecting them away

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Conclusion