Repeat Attendances Research Articles

A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients.

Very little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination. To gain rare insight into Irish Traveller patients' emergency healthcare utilisation and outcomes. A retrospective general practice review of A&E attendances was performed from January to December 2017, comparing Travellers with the rest of the practice patient population. A search was done for all A&E attendance letters and related admissions. Blind review of the diagnosis and management were assessed by two reviewers for appropriateness of attendance at A&E. The frequency and recurrence of A&E attendances, referral pathway toA&E, location of A&E, and age distribution were compared. Traveller patients attending A&E were younger. There were fewer repeat attendances in the travelling community but proportionally more in the Traveller under-20-year-old cohort. Only 38% of A&E attendances in Travellers (56% non-Travellers) were deemed appropriate (χ2 7.16, P = 0.007). Only 20% of Travellers (36% non-Travellers) attending A&E were admitted to hospital (χ2 6.33, P = 0.01). Further, 93% of A&E attendances in Irish Travellers (75% non-Travellers) did not follow initial contact with either a GP or NHS 111 (χ2 9.86, P<0.002). Finally, 51% of Irish Travellers (6% non-Travellers) attended A&E departments distant to their registered GP practice (χ2 89.5, P<0.001). This work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.

Using ambulance surveillance data to characterise blood-borne viral infection histories among patients presenting with acute alcohol and other drug-related harms.

Preventable transmission of blood-borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at-risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD-related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD-related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. Our study describes the utility of ambulance data to identify a sub-population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services.

Development and Internal Validation of a Multivariable Prediction Model to Predict Repeat Attendances in the Pediatric Emergency Department: A Retrospective Cohort Study.

Unplanned reattendances to the pediatric emergency department (PED) occur commonly in clinical practice. Multiple factors influence the decision to return to care, and understanding risk factors may allow for better design of clinical services. We developed a clinical prediction model to predict return to the PED within 72 hours from the index visit. We retrospectively reviewed all attendances to the PED of Royal Manchester Children's Hospital between 2009 and 2019. Attendances were excluded if they were admitted to hospital, aged older than 16 years or died in the PED. Variables were collected from Electronic Health Records reflecting triage codes. Data were split temporally into a training (80%) set for model development and a test (20%) set for internal validation. We developed the prediction model using LASSO penalized logistic regression. A total of 308,573 attendances were included in the study. There were 14,276 (4.63%) returns within 72 hours of index visit. The final model had an area under the receiver operating characteristic curve of 0.64 (95% confidence interval, 0.63-0.65) on temporal validation. The calibration of the model was good, although with some evidence of miscalibration at the high extremes of the risk distribution. After-visit diagnoses codes reflecting a nonspecific problem ("unwell child") were more common in children who went on to reattend. We developed and internally validated a clinical prediction model for unplanned reattendance to the PED using routinely collected clinical data, including markers of socioeconomic deprivation. This model allows for easy identification of children at the greatest risk of return to PED.

Suicidal Crisis among Children and Young People: Associations with Adverse Childhood Experiences and Socio-Demographic Factors.

Suicide is a major public health issue and a leading cause of death among children and young people (CYP) worldwide. There is strong evidence linking adverse childhood experiences (ACEs) to an increased risk of suicidal behaviours in adults, but there is limited understanding regarding ACEs and suicidal crises in CYP. This study aims to examine the ACEs associated with CYP presenting at Emergency Departments for suicidal crises, and specifically the factors associated with repeat attendances. This is a case series study of CYP (aged 8-16) experiencing suicidal crisis who presented in a paediatric Emergency Department in England between March 2019 and March 2021 (n = 240). The dataset was subjected to conditional independence graphical analysis. Results revealed a significant association between suicidal crisis and several ACEs. Specifically, evidence of clusters of ACE variables suggests two distinct groups of CYP associated with experiencing a suicidal crisis: those experiencing "household risk" and those experiencing "parental risk". Female sex, history of self-harm, mental health difficulties, and previous input from mental health services were also associated with repeat hospital attendances. Findings have implications for early identification of and intervention with children who may be at a heightened risk for ACEs and associated suicidal crises.

Seizures and emergency department: characteristics and factors of repeat adult attendees.

To identify risk factors and characteristics for the repeated attendance at an emergency department (ED) following a seizure. A retrospective cohort study was conducted using non-identifiable data of individuals attending ED at least twice between 2015 and 2018, following a seizure. Data were drawn from the patient administration system of an English rural medium-sized teaching district general hospital emergency department (ED), serving a population of 566,000 people. It was analysed for bio-psycho-social features associated with repeat attendances. Of 3522 seizure-related attendances in the four years, 450 people were identified to be repeaters attending on two or more occasions (range 2-12). Just over a quarter (27%) were 18-29years old. Higher likelihood of re-attendance was associated with social deprivation and no fixed abode. Mental illness was a significant co-morbidity influencing repeat attendances. Nearly half (47%) had no recorded anti-seizure medication (ASM). Three fifth (60%) were on general medication and a quarter (25%) on psychotropics. Nearly a quarter (22%) had alcohol and recreational drug concerns. Just over a quarter (28%) had no previous epilepsy diagnosis. Nearly a fifth (n = 85, 19%) died during the study period. People who present repeatedly with seizures at ED are at significant risk of death over a four-year period and require pro-active clinical follow-up. People who are homeless or from socially deprived areas are over-represented in this group, as are those with alcohol problems, co-morbid mental health conditions and compliance issues. This suggests enhanced targeted intervention for this cohort is needed.

Urgent dental care use in the North East and Cumbria: predicting repeat attendance

Introduction Around one-third of the UK population are 'problem-orientated dental attenders', only seeking care when suffering with dental pain and often on a repeated basis to secondary care. Little is known about attendance in primary care. The aim here was to examine the period prevalence of repeat urgent care attenders and establish predictors of repeat attendance in primary care.Methods Data on urgent and emergency dental care attendances in primary dental care in the North East and Cumbria were analysed from 2013-2019. Variables included: patient sex; ten-year age band; lower super output area; and Index of Multiple Deprivation. Period prevalence was calculated and data were considered year by year to identify trends in attendances. Analysis was with descriptive statistics and predictors of repeat attendance were identified using logistic regression modelling.Results Over the six-year period, there were 601,432 attendances for urgent primary dental care, equating to a period prevalence of 2.76% for the geographic population studied. In total, 16.15% of attendances were repeat attendances (period prevalence 0.45%) and predictors included being a woman and residence in deprived and rural areas. All urgent care attendances decreased over the six-year period, with one-off attendances beginning to increase again in 2019, while repeat attendances stabilised.Conclusion Interventions to encourage regular dental attendances should be targeted at patients from the most deprived and rural areas of the North East and Cumbria; however, a decrease in repeat attendance was noted in these areas.

People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, \u201cHypos can strike twice\u201d: a mixed methods process evaluation

BackgroundHypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and self-managed if expert support, such as education on lifestyle and treatment, is provided. Our aim was to conduct a process evaluation to investigate how ambulance staff and PWD perceived the “Hypos can strike twice” booklet-based ambulance clinician intervention, including acceptability, understandability, usefulness, positive or negative effects, and facilitators or barriers to implementation.MethodsWe used an explanatory sequential design with a self-administered questionnaire study followed by interviews of people with diabetes and ambulance staff. We followed the Medical Research Council framework for process evaluations of complex interventions to guide data collection and analysis. Following descriptive analysis (PWD and staff surveys), exploratory factor analysis was conducted to identify staff questionnaire subscales and multiple regression models were fitted to identify demographic predictors of overall and subscale scores.Results113 ambulance staff members and 46 PWD completed the survey. We conducted interviews with four ambulance staff members and five PWD who had been attended by an ambulance for a hypoglycaemic event. Based on surveys and interviews, there were positive attitudes to the intervention from both ambulance staff and PWD. Although the intervention was not always implemented, most staff members and PWD found the booklet informative, easy to read and to use or explain. PWD who completed the survey reported that receiving the booklet reminded and/or encouraged them to test their blood glucose more often, adjust their diet, and have a discussion/check up with their diabetes consultant. Interviewed PWD felt that the booklet intervention would be more valuable to less experienced patients or those who cannot manage their diabetes well. Overall, participants felt that the intervention could be beneficial, but were uncertain about whether it might help prevent a second hypoglycaemic event and/or reduce the number of repeat ambulance attendances.ConclusionsThe ‘Hypos may strike twice’ intervention, which had demonstrable reductions in repeat attendances, was found to be feasible, acceptable to PWD and staff, prompting reported behaviour change and help-seeking from primary care.Trial registrationRegistered with ClinicalTrials.gov: NCT04243200 on 27 January 2020.

Accuracy of radiographer preliminary clinical evaluation of skeletal trauma radiographs, in clinical practice at a district general hospital

IntroductionError in interpretation of trauma radiographs by referrers is a problem which has detrimental effects on the patient and causes unnecessary repeat attendances. Radiographers can reduce errors by offering their opinion at the time of imaging. The Society and College of Radiographers have a longstanding recommendation that Red Dot (RD) schemes should be replaced by Preliminary Clinical Evaluation (PCE). The purpose of the study was to evaluate radiographer interpretation of skeletal trauma radiographs in clinical practice, determine if there was any difference in ability to interpret appendicular and axial studies, and evaluate appropriateness of PCE implementation. MethodsA convenience sample of 23 self-selecting radiographers provided RD and PCE on 762 examinations. Each case was compared against the verified report and assigned a true negative/positive or false negative/positive value. Accuracy, sensitivity and specificity were calculated and performance measures between RD versus PCE, and appendicular versus axial were compared using Two-sample Z-Tests. Error analysis was performed and inter-observer consistency determined. ResultsOverall RD and PCE accuracy, sensitivity and specificity for the study were 90%, 72% and 97% (RD), and 92%, 80% and 97% (PCE) respectively. Significant difference was demonstrated for sensitivity with PCE more sensitive than RD (p-value 0.03) and appendicular more sensitive than axial (RD p-value <0.02, PCE p-value <0.0001). Most errors were false negatives. Inter-observer consistency was evaluated by review of 128 cases and no difference between reviewers was established. ConclusionRadiographers without specific training were able to provide RD and PCE to a high standard. Radiographers interpreted positive findings more accurately using PCE than RD, and positive findings on appendicular cases were interpreted more accurately than those on axial cases. Implications for practiceThis study supports local PCE implementation, contributes to the wider evidence base to justify transition towards PCE and identifies the necessity for local axial image interpretation training.

The effects of a leaflet-based intervention, 'Hypos can strike twice', on recurrent hypoglycaemic attendances by ambulance services: A non-randomised stepped wedge study.

We aimed to investigate the effect of an intervention in which ambulance personnel provided advice supported by a booklet-'Hypos can strike twice'-issued following a hypoglycaemic event to prevent future ambulance attendances. We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation within East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0), no clusters were exposed to the intervention, and during the last step (T3), all clusters were exposed. Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA). The study included 4825 patients (mean age 65.42years, SD 19.42; 2,166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances (i.e., attendance followed by a repeat attendance) in the final step of the intervention when compared to the first (odds ratio OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia-relative to the pre-intervention trend (p=0.008). Furthermore, the hypoglycaemia care bundle was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (p<0.001). The 'Hypos can strike twice' intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of information booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.

Investigative strategies for fish bone foreign bodies during the coronavirus disease 2019 pandemic: an analysis of ENT UK guidelines.

By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination. Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic. Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy. This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.

Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study

ObjectiveTo create a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the...

Dental pain in the medical emergency department: a cross-sectional study.

The aim of this study was to examine the number of patients attending a medical emergency department (MED) with dental problems over a three-year period. This cross-sectional study was carried out as part of a service evaluation. Data were collected via a database search of patient attendances at the MED using free text and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for oral and dental diagnoses. Data were analysed using descriptive statistics, t-test and chi-squared tests. Over the three-year period, there were 2504 visits to the MED for dental-related complaints, accounting for 0·7% of all attendances. The majority of patients were male (53·9%), with a mean age of 29 (s.d. 19·4) years for men, and 32 (s.d. 19·7) years for females. The mean index of multiple deprivation per cent rank was 35·0%. The most common diagnosis was unspecified dental disorder. Ten per cent of dental attendances to MED were repeat attendances by the same patients. In conclusion, patient attendances at MED for dental problems account for 0.7% of all attendances. MED may not be the most appropriate place for these patients to attend, in terms of care pathways, and also for economic reasons. The reasons why patients attend MED for dental problems clearly warrant further research.

P052 Men who have sex with men (MSM) presenting with repeat bacterial Sexually transmitted infections (STI) report high use of alcohol and party drugs

Background/introduction Bacterial sexually transmitted infections (Chlamydia, Gonorrhoea and Syphilis) are increasing in men who have sex with men in the UK. The reasons for this include alcohol and recreational drug use, availability of PrEP and awareness of HIV treatment as prevention, and social media. Aim(s)/objectives Our aim was to investigate the factors associated with recurrent bacterial STIs in MSM in Brighton, focusing specifically on drug and alcohol use. Methods We reviewed MSM presenting to our service between September 2014-September 2015 who had had 3 or more repeat attendances with a bacterial STI. We included infectious Syphilis, pharyngeal, rectal and urethral Chlamydia and Gonorrhoea. We collected data on alcohol and recreational drug use. Results An estimated 11,000 MSM attended during the study period. Of these, 46 MSM had 3 or more bacterial STIs. The median age was 34.5 years 21–57). 26/46 (57%) were HIV positive. 32/46 (70%) had 3 STIs; 10/46 (22%) had 4 STIs, 3/46 (7%) had 5 STIs and 1/46 (2%) had 6 STIs. 14/46 (30%) reported hazardous drinking, 31/46 (67%) reported use of party drugs (including Mephedrone, Crystal Meth, Ecstasy and GHB) and 7/46 (15%) reported ‘slamming’. Discussion/conclusion MSM attending multiple times with recurrent bacterial STIs also report high use of alcohol and recreational drug use including slamming. Public health interventions to reduce incidence of STIs should include focusing on drug and alcohol use in MSM.

Prospective audit of a dedicated ear, nose and throat emergency department and 24-year comparison.

The Royal Victoria Eye and Ear Hospital provides a specialised ear, nose and throat (ENT) Emergency department (ED) service open to patients from the entire country, operating from 9 am to 5 pm on weekdays. Recently, this has been under threat of closure. We analyse and determine the role of this ED in the current context and compare results to a previous study from June 1990. A prospective study over a 1-month period (March 2014) was conducted. A questionnaire was used, adapted from the study in 1990. Comparative figures from June 1990 are in parentheses. During the study period, there were 945 (1167) consultations from 887 (779) patients. 57% (45%) were new patients and 43% (55%) were return patients. Repeat attendances were necessary in 54 (325) patients during this month. 56% (35%) were referred by their General Practitioner (GP), 38% (52%) self-referred, 2% (8%) by other hospitals and 4% (5%) from other sources. Diagnoses included otitis externa in 24% (21%), cerumen in 20% (15%), epistaxis in 6% (9%), Eustachian tube dysfunction in 12%, foreign body removal in 4% (5%) and four new cases of head and neck cancer. Attendance numbers vary during the year but demand has risen over time. A dedicated ED provides an important role for ENT in Ireland and offers valuable experience for trainees. The loss of such a department may lead to an overwhelming burden on services in other hospitals.

Frequent attendances to National Health Service general practitioner-led urgent care centres in London: an observational study

BackgroundSome patients attend emergency departments more frequently than others and account for a disproportionate number of attendances. However, little is known about repeat attenders at National Health Service urgent care centres. We aimed to describe the volume and characteristics of repeat attenders at such centres. MethodsIn an observational study, we analysed routine attendance data at two urgent care centres in London. We included all adult patients (aged 18 years and older) who attended either centre at least once between Jan 1, 2010, and Dec 31, 2012. We used Poisson regression models to predict the characteristics of frequent attenders. For each patient, the outcome variable was the numbers of repeat visits, and the exposure variable was length of follow-up. The predictors were age, sex, and risk factors recorded at the first visit (socioeconomic status, ethnicity, centre attended, referral to an accident and emergency [A&E] department, referral to a non-A&E service, mental health indication, number of diagnoses, and general practitioner [GP] registration status). We also estimated population attributable fractions for the non-base levels of each risk factor. Findings189 614 attendances were made by 108 677 patients. Although only 3116 (2·9%) attended more than five times, they accounted for a disproportionate number (26 826, 14·1%) of the total attendances. The strongest predictor of frequent attendance was low socioeconomic status (population attributable fraction for men 0·501, 95% CI 0·446–0·550; women 0·353, 0·281–0·418). Frequent attendees were commonly of non-white ethnicity (men 0·057, 0·038–0·076; women 0·030, 0·017–0·044) and unregistered with a GP (men 0·021, 0·015–0·027; women 0·017, 0·013–0·020). Patients referred to non-A&E services at their first visit were less likely to re-attend (men −0·020, −0·024 to −0·015; women −0·011, −0·015 to −0·007). InterpretationAlthough very few patients attended the centres frequently, they contributed disproportionally to the workload of the centres. Patients of low socioeconomic status, non-white ethnicity, and unregistered with a GP were more likely to attend frequently. Interventions to reduce repeat attendances could target these populations via educational programmes or enhanced access to community-based services. The generalisability of these findings is limited because data come from only two urgent care centres in London. FundingThis study was funded by a grant from the Imperial College NHS Trust Healthcare Charity and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London.

Emergency demand and repeat attendances by older patients

Population ageing is projected to impact on health services utilisation including Emergency Departments (ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits. Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥ 70 years) and younger (15-69 years) attendances. Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥ 70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥ 4 times in 2008/2009. The number of older patients presenting ≥ 4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age; 69% of older adults remained in ED for ≥ 4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade. Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients.

Getting it right: the impact of a continuing medical education program on hepatitis B knowledge of Australian primary care providers

Introduction:In Australia, chronic hepatitis B (CHB) disproportionately affects migrants born in hepatitis B endemic countries, but its detection and management in high risk populations remains suboptimal. We piloted a primary care based program for CHB detection and management in an area of high disease prevalence in Sydney, Australia. Prior to its launch, all local general practitioners were invited to take part in a continuing medical education (CME) program on hepatitis B diagnosis and management.Material and methods:Preceding each CME activity, participants completed an anonymous survey recording demographic data and hepatitis B knowledge, confidence in CHB management, and preferred CME modalities. We compared knowledge scores of first-time and repeat attendees.Results:Most participants (75%) were males, spoke more than one language with their patients (91%), self-identified as Asian-Australians (91%), and had graduated over 20 years previously (69%). The majority (97%) knew what patient groups require CHB and hepatocellular cancer screening, but fewer (42%–75%) answered hepatitis B management and vaccination questions correctly. Knowledge scores were not significantly improved by seminar attendance and the provision of hepatitis B resources. At baseline, participants were fairly confident about their ability to screen for CHB, provide vaccinations, and manage CHB. This did not change with repeat attendances, and did not correlate with survey outcomes. Large group CMEs were the preferred learning modality.Discussion:Knowledge gaps in hepatitis B diagnosis and management translate into missed opportunities to screen for CHB, to vaccinate those susceptible, and to prevent disease complications. The results suggest that a range of innovative CME programs are required to update general practitioners on the modern management of CHB infection.

Explaining the laws of unplanned care

Unplanned care (accident and emergency attendances and emergency admissions) may be defined as three separate, but connected laws. The need for local healthcare economies to reduce the total levels of unplanned care in a financial year means that they require an approach to determine where they should be focusing their efforts and why. The three laws offer this, as they can be used to explain unplanned care and to dispel any number of viewpoints that fall outside of them. They are based on a set way of collecting and analysing unplanned care data that distinguishes between the unique individuals that experience, for example an accident and emergency attendance and the number of subsequent repeat attendances by individual.

The role of health and non-health-related factors in repeat emergency department visits in an elderly urban population

IntroductionPatients aged 65 years or older account for a growing proportion of emergency department (ED) repeat attendances. This study aimed to identify health and non-health factors associated with repeat ED...

Predictors of frequent attenders of emergency department at an acute general hospital in Singapore

ObjectiveTo determine factors associated with frequent emergency department (ED) attendance at an acute general hospital in Singapore.MethodPatients who attended the ED from 1 January to 31 December 2006 without prior...