Recurrent Users of ER at Higher Risk of Death and Admission

A new study finds that frequent users of emergency departments (EDs) appear to experience higher mortality, hospital admissions, and outpatient visits compared with non-frequent users.

Researchers at the University of Alberta (Edmonton, Canada) conducted a systematic review of literature to test if high ED visiting rates resulted in higher mortality, hospital admission, and outpatient visit rates than other users. The researchers identified 4,004 citations; 374 were screened by full text, and 31 cohort and cross-sectional studies were included in the final analysis, relating to the years between 1990 and 2013. Frequent use was defined as visiting EDs between 4 and 20 times a year.

The analysis concludes that frequent users had a median 2.2-fold increased odds than infrequent users to die, be admitted to hospital, or need other outpatient treatment. The researchers could not answer why this was so, but associated it with the heterogeneous character of high-needs patients, including those with mental health and addiction issues, homelessness or unstable housing, chronic diseases, and conditions that transient increased needs, such as cellulitis, abscess treatment, missed diagnoses, and complications. The study was published online on May 7, 2015, in Emergency Medicine Journal.

“Clearly, to view frequent users as merely a nuisance or drain on resources represents a narrow, biased, and potentially dangerous view of this issue,” concluded lead author Jessica Moe, MD, of the department of emergency medicine, and colleagues. “Our findings suggest that frequent ED users merit focused attention, continued research, and implementation of interventions designed to meet their unmet needs from practitioners, health administrators and policymakers.”

Frequent ED users account for less than a tenth of all ED patients, but are estimated to contribute to between a fifth and toward a third of all visits. Many of these patients use the ED as an access point to healthcare, often with problems that are not emergencies and for which care could actually be better provided for by primary care providers or outpatient clinics. But mental, social, economic, and logistical barriers prevent these patients from pursuing the normal avenues to healthcare, and the ED is typically thus the easiest option.

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