Abstract
Introduction: The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period.Methods: This was an institutional review board approved, retrospective review of all patients who presented to the ED 5 or more times for 3 distinct time periods: “year 0” 11/98–10/99, “year 5” 11/03– 10/04, and “year 10” 11/08–10/9. FEDU were grouped into those with 5–9, 10–14, 15–19, and ≥ 20 visits per year. Variables analyzed included number of visits, disposition, and insurance status. We performed comparisons using Kolmogorov-Smirnov and chi-square tests. A p<0.05 was considered significant.Results: We found a a 66% increase in FEDU patients over the decade studied, with a significant increase in both the number of FEDU in each visit frequency category over the 3 time periods (p<0.001), as well as the total number of visits by each group of FEDU (p<0.001). The proportion of FEDU visits for the 5–9 group resulting in admission increased from 25.9% to 29% from year 0 to year 10 (p<0.001), but not for the other visit groups. In comparing admission rates between FEDU groups, the admission rate for the 5–9 group was significantly higher than the ≥ 20 group for the year 5 time period (p<0.001) and the year 10 time period (p<0.001) and showed a similar trend, but not significant, at year 0 (p=0.052). The overall hospital admission rate for emergency patients over the same time span remained stable at 22–24%. The overall proportion of uninsured FEDU was stable over the decade studied, while the uninsured rate for the overall ED population for the same time periods increased.Conclusion: The results demonstrate the FEDU population is not a homogeneous group of patients. Increased attention to differences among FEDU groups is necessary in order to plan more effective interventions.
Highlights
The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period
The overall proportion of uninsured FEDU was stable over the decade studied, while the uninsured rate for the overall ED population for the same time periods increased
Increased attention to differences among FEDU groups is necessary in order to plan more effective interventions. [West J Emerg Med. 2013;14(3):243–246.]
Summary
The purpose of this study was to determine if differences could be detected in the presentation patterns and admission rates among frequent emergency department users (FEDU) of an urban emergency department over a 10-year period. From 1998 to 2008 the number of emergency department (ED) visits increased by 30% from 94.8 million to 123 million, while the total national number of hospital-based EDs declined by 3.3% according to the American Hospital Association.[1] The Centers for Disease Control and Prevention (CDC) has reported that in 2007, approximately 1 in 5 persons in the United States (U.S.) population had 1 or more ED visits in a 12-month period.[2] Frequent ED Users (FEDU) are a diverse group of patients responsible for a disproportionate number of ED visits.[3,4,5,6] It is not well understood how FEDU have contributed to the overall increases in ED volumes, or in hospital admissions. Previous studies have described a variety of FEDU demographic characteristics but these studies have not described subgroups of FEDU relative to their presentation and admission patterns over extended periods of time.[3,4,5,6,7,8,9,10]
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