Service use by older very frequent emergency department users: A retrospective cohort study

Abstract

BackgroundFrequent Emergency Department (ED) attendance is a common occurrence, across all patient age groups. Older frequent users of ED are an at-risk group who often have complex, chronic health needs with many requiring out-of-hospital services to support their care.The aim of this study is to identify the characteristics, outcomes and health service use of older, very frequent emergency department (ED) users. MethodsA retrospective cohort study, at three Australian EDs, comparing first and last ED attendances, by older people (≥65 years) with frequent ED use (≥8 attendances/year). ResultsThere were 1387 ED attendances in 12 months by 115 patients (median=11). The median age-adjusted Charlson comorbidity score increased between attendances (5 vs 6, p<0.001). From first to last visit, hospital stays exceeding 7 days increased (12% vs 20%, p=0.013), while both ED re-attendances within 28 days (58% vs 20%, p≤0.001) and hospital readmissions within 30 days (39% vs 23%, p=0.016) decreased. In-patient mortality was 11% (n=10/88). There was no change in out-of-hospital services in place at both ED attendances (55% vs 61%, p=0.185). ConclusionsOut-of-hospital service use did not change despite frequent ED attendance. Older very frequent ED users had increasing co-morbidities over time and often required hospital admission.