Frequent attenders at the emergency department: an analysis of characteristics and utilisation trends

Abstract

Background: Frequent attenders (FAs) place a disproportionate burden on emergency department (ED) resources. Objectives: Our study aimed to describe characteristics of ED visits by FAs to our hospital so as to identify potential strategies to better manage ED demand. Methods: This was a retrospective observational study. All visits to the ED from 1 January 2011 to 31 December 2011 were included. FAs were defined as patients with ⩾5 visits to the ED over the study period. They were further stratified by visit frequency. Results: FAs showed a bimodal age distribution, with visits by FAs aged 16–25 years old and the elderly aged 66 years and above accounting for the largest proportion of ED visits relative to the number of visits by their non-FA counterparts. Using the age group of 26–45 years as reference, the odds ratio (OR) of FAs being 16–25 years old was 3.037 (95% confidence interval (CI) 2.708–3.407, p < 0.001). Above the age of 65, the OR of FAs falling into a given age group increased for every additional decade of life, up to 3.118 (2.495–3.898, p <0.001) for the age group of 86 and above. FAs were more likely to be male. Diagnoses which accounted for a higher percentage of visits with increasing visit frequency were asthma, chronic obstructive pulmonary disease, upper respiratory tract infection and headache. Conclusions: FAs include the high-acuity chronic sick as well as young adults with low-acuity complaints. Disease optimisation programmes, case management, robust community-based healthcare and public education are possible avenues to optimise ED resources in an ageing society.