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Kim SH, Lee H. Characteristics of consecutive versus non-consecutive frequent emergency medical services transport to a single emergency department. PLoS One 2024; 19:e0301337. [PMID: 38722985 PMCID: PMC11081241 DOI: 10.1371/journal.pone.0301337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/14/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE This study was to examine characteristics concerning frequent users of emergency medical services (EMS) transport by comparing patients who used EMS transport frequently for one year and those who used EMS transport for more than two years consecutively. METHODS A retrospective review for frequent use of EMS transport was conducted. The patients from the fire stations that transported more than 70% of all EMS transport to the study hospital emergency department (ED) were included. The study subjects were divided into consecutive group (frequent EMS transport for ≥ two years consecutively) and non-consecutive group (frequent EMS transport for only one year). Characteristics of patients who were frequent users of EMS transport and those of all cases with EMS transport were examined. RESULTS Of the total 205 patients and 1204 cases of frequent EMS transport, 85 (42%) patients and 755 (63%) cases were in the consecutive group. Patients in the consecutive group were more likely to have risky alcohol use, unemployed state, and medical aid type of payment for ED treatment than those in the non-consecutive group. More patients had previous experience of EMS transport to the study hospital ED in the consecutive group and the number of cases with alcohol ingestion was higher in the consecutive group. Elapsed time from EMS call to ED arrival was longer for the consecutive group. CONCLUSION Risky alcohol use, unemployed state, and previous experience of EMS transport were associated with consecutive and frequent use of EMS transport in frequent users of EMS transport.
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Affiliation(s)
- Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyeji Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Zhou JG, Cameron PA, Dipnall JF, Shih K, Cheng I. Using network analyses to characterise Australian and Canadian frequent attenders to the emergency department. Emerg Med Australas 2023; 35:225-233. [PMID: 36216495 DOI: 10.1111/1742-6723.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore and compare the characteristics of frequent attenders to the ED at an Australian and a Canadian tertiary hospitals by utilising a network analysis approach. METHODS We conducted a retrospective population-based study using administrative data over the 2018 and 2019 calendar years. Participants were from a tertiary hospital in Melbourne, Australia, and Toronto, Canada. Frequent attenders were defined as patients with four or more visits in 12 months. Characteristics of younger (18-39 years), middle-aged (40-69 years) and older (70 years and older) frequent attenders were described using descriptive statistics and network analyses. RESULTS Younger frequent attenders were characterised by mental illness and substance use, while older frequent attenders had high rates of physical (including chronic) diseases. Middle-aged frequent attenders were characterised by a combination of mental and physical illnesses. These findings were observed at both hospitals. Across all age groups, the network analyses between the Melbourne and Toronto hospitals were different. Among older frequent attender visits, more diagnoses were associated with high triage acuity at the Toronto hospital than at the Melbourne hospital. Some associations were similar at both sites, for example, the negative correlation between high triage acuity and joint pain. CONCLUSION Younger, middle-aged and older frequent attenders have distinct characteristics, made readily apparent by using network analyses. Future interventions to reduce ED visits should consider the heterogeneity of frequent attenders who have needs specific to their age, presenting problems and jurisdiction.
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Affiliation(s)
- Jonathan G Zhou
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Joanna F Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Kingsley Shih
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Vrijlandt SEW, Nieboer D, Zachariasse JM, Oostenbrink R. Characteristics of pediatric emergency department frequent visitors and their risk of a return visit: A large observational study using electronic health record data. PLoS One 2022; 17:e0262432. [PMID: 35085300 PMCID: PMC8794145 DOI: 10.1371/journal.pone.0262432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Among pediatric emergency department (ED) visits, a subgroup of children repeatedly visits the ED, making them frequent visitors (FVs). The aim of this study is to get insight into the group of pediatric ED FVs and to determine risk factors associated with a revisit. Methods and findings Data of all children aged 0–18 years visiting the ED of a university hospital in the Netherlands between 2017 and 2020 were included in this observational study based on routine data extraction. Children with 4 or more ED visits within 365 days were classified as FVs. Descriptive analysis of the study cohort at patient- and visit-level were performed. Risk factors for a recurrent ED visit were determined using a Prentice Williams and Peterson gap time cox-based model. Our study population of 10,209 children with 16,397 ED visits contained 500 FVs (4.9%) accounting for 3,481 visits (21.2%). At patient-level, FVs were younger and more often suffered from chronic diseases (CDs). At visit-level, frequent visits were more often initiated by self-referral and were more often related to medical problems (compared to trauma’s). Overall, FVs presented at the ED more often because of an infection (41.3%) compared to non-FVs (27.4%), either associated or not with the body system affected by the CD. We identified the presence of a comorbidity (non-complex CD HR 1.66; 1.52–1.81 and complex CD HR 2.00; 1.84–2.16) as determinants with the highest hazard for a return visit. Conclusion Pediatric ED FVs are a small group of children but account for a large amount of the total ED visits. FVs are younger patients, suffering from (complex) comorbidities and present more often with infectious conditions compared to non-FVs. Healthcare pathways, including safety-netting strategies for acute manifestations from their comorbidity, or for infectious conditions in general may contribute to support parents and redirect some patients from the ED.
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Affiliation(s)
- Sanne E. W. Vrijlandt
- Department of General Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Daan Nieboer
- Center for Medical Decision Sciences, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Joany M. Zachariasse
- Department of General Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
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Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E232-E246. [PMID: 35292481 PMCID: PMC8929427 DOI: 10.9778/cmajo.20210132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. METHODS This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health-related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. RESULTS The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: "short duration" (frequent, regularly spaced visits), "older patients" (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), "young mental health" (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health-related and alcohol-related visits) and "injury" (increased prevalence of injury-related visits). INTERPRETATION From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
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Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E220-E231. [PMID: 35292480 PMCID: PMC8929439 DOI: 10.9778/cmajo.20210131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. METHODS This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health-related hospitalization data. RESULTS We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use-related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. INTERPRETATION Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
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David M, Richter R, Naghavi B, Borde T, Razum O, Somasundaram R, Stein H, Sehouli J. [Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status]. Notf Rett Med 2021; 25:252-259. [PMID: 33649703 PMCID: PMC7904028 DOI: 10.1007/s10049-021-00851-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Fragestellung Welche prädiktiven Faktoren lassen sich für die Gruppe der sog. Mehrfachnutzer (MFN; 4 und mehr Inanspruchnahmen einer Notaufnahme [NA] in den letzten 12 Monaten) finden? Sind Personen mit Migrationshintergrund häufiger in die Gruppe der MFN einzuordnen? Methodik Konsekutive Patienten, die von Juli 2017 bis Juli 2018 drei Klinik-NA in Berlin aufsuchten. Mittels Fragebogen Erfassung von Erkrankungen, Gründen für den NA-Besuch und sozioökonomischen Faktoren. Die Unterschiede zwischen Migranten (1. Generation), ihren Nachkommen (2. Generation) und Nichtmigranten wurden mithilfe der logistischen Regression bewertet. Ergebnisse 2339 Patienten konnten in die Auswertung einbezogen werden (Rücklaufrate 56 %), davon hatten 901 einen Migrationshintergrund. Bei jungen Frauen (<30 Jahre), chronisch Kranken, Schwangeren, Patientinnen und Patienten mit starken Beschwerden und Personen mit (selbsteingeschätzter) mittlerer und schlechter „Gesundheitsqualität“ sowie solchen ohne ärztliche Zuweisung war die Chance für eine Mehrfachnutzung der NA größer. Schlussfolgerung MFN belasten das ohnehin zunehmende Patientenvolumen von NA. Sie stellen jedoch eine heterogene Patientengruppe dar, unter der Menschen mit Migrationshintergrund nicht häufiger vertreten sind. Weitere Untersuchungen sind erforderlich, um die Faktoren, die zu einer häufigen Inanspruchnahme führen, besser zu verstehen und wirksame Strategien zu entwickeln, um den komplexen Gesundheitsbedürfnissen von MFN gerecht zu werden.
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Affiliation(s)
- Matthias David
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Rolf Richter
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Baharan Naghavi
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Theda Borde
- Alice Salomon-Hochschule Berlin, Berlin, Deutschland
| | - Oliver Razum
- Fakultät für Gesundheitswissenschaften, AG 3: Epidemiologie und International Public Health, Universität Bielefeld, Bielefeld, Deutschland
| | - Rajan Somasundaram
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hendrike Stein
- Rettungsstelle, Vivantes Klinikum Berlin-Neukölln, Berlin, Deutschland
| | - Jalid Sehouli
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
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Shannon B, Pang R, Jepson M, Williams C, Andrew N, Smith K, Bowles KA. What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis. Intern Emerg Med 2020; 15:1303-1316. [PMID: 32557095 DOI: 10.1007/s11739-020-02403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Patients who frequently attend to emergency departments are a varying group and have complex health care needs. This systematic review and meta-analysis aimed to determine the prevalence of patients who have frequent attendance to emergency departments. A systematic review was performed in line with PRISMA guidelines. A database search was conducted, and studies were included in the final review if they analysed a population of frequent attendance. Meta-analysis was performed only on population-based studies to estimate prevalence. The search yielded 2922 nonduplicate publications, of which 27 were included in the meta-analysis. The most common definition used for frequent attendance was greater than three presentations a year. The proportion of people who frequently attended as a percentage of the total study population ranged from 0.01 to 20.9%, with emergency department presentations from frequent attenders ranging from 0.2 to 34%. When limiting the definition of frequent attendance to greater than three visits in a 12-month period, people who frequently attended contributed between 3 and 10% [pooled estimate 6%; CI 4-7%] of emergency department presentations and between 12 and 34% [pooled estimate 21%; CI 15-27%] of total emergency department presentations. Meta-analysis found substantial heterogeneity between estimates [I2 > 50%]. The prevalence of frequent attendance compared to the total population of patients seeking emergency care was small, but the impact on emergency department utilisation is significant. Early identification of people attending for frequent care at an emergency department provides the opportunity to implement alternative models of care.
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Affiliation(s)
- Brendan Shannon
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia.
- Ambulance Victoria, Melbourne, VIC, Australia.
| | - Rebecca Pang
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Peninsula Clinical School-Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Megan Jepson
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
| | - Cylie Williams
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Nadine Andrew
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Peninsula Clinical School-Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
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Maruster L, van der Zee DJ, Hatenboer J, Buskens E. Tracing frequent users of regional care services using emergency medical services data: a networked approach. BMJ Open 2020; 10:e036139. [PMID: 32467254 PMCID: PMC7259845 DOI: 10.1136/bmjopen-2019-036139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study shows how a networked approach relying on 'real-world' emergency medical services (EMS) records might contribute to tracing frequent users of care services on a regional scale. Their tracing is considered of importance for policy-makers and clinicians, since they represent a considerable workload and use of scarce resources. While existing approaches for data collection on frequent users tend to limit scope to individual or associated care providers, the proposed approach exploits the role of EMS as the network's 'ferryman' overseeing and recording patient calls made to an entire network of care providers. DESIGN A retrospective study was performed analysing 2012-2017 EMS calls in the province of Drenthe, the Netherlands. Using EMS data, benefits of the networked approach versus existing approaches are assessed by quantifying the number of frequent users and their associated calls for various categories of care providers. Main categories considered are hospitals, nursing homes and EMS. SETTING EMS in the province of Drenthe, the Netherlands, serving a population of 491 867. PARTICIPANTS Analyses are based on secondary patient data from EMS records, entailing 212 967 transports and 126 758 patients, over 6 years (2012-2017). RESULTS Use of the networked approach for analysing calls made to hospitals in Drenthe resulted in a 20% average increase of frequent users traced. Extending the analysis by including hospitals outside Drenthe increased ascertainment by 28%. Extending to all categories of care providers, inside Drenthe, and subsequently, irrespective of their location, resulted in an average increase of 132% and 152% of frequent users identified, respectively. CONCLUSIONS Many frequent users of care services are network users relying on multiple regional care providers, possibly representing inefficient use of scarce resources. Network users are effectively and efficiently traced by using EMS records offering high coverage of calls made to regional care providers.
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Affiliation(s)
- Laura Maruster
- Innovation Management & Strategy, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Durk-Jouke van der Zee
- Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Jaap Hatenboer
- Ambulancezorg, UMCG, Tynaarlo, Groningen, The Netherlands
| | - Erik Buskens
- Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ng SHX, Rahman N, Ang IYH, Sridharan S, Ramachandran S, Wang DD, Tan CS, Toh SA, Tan XQ. Characterization of high healthcare utilizer groups using administrative data from an electronic medical record database. BMC Health Serv Res 2019; 19:452. [PMID: 31277649 PMCID: PMC6612067 DOI: 10.1186/s12913-019-4239-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background High utilizers (HUs) are a small group of patients who impose a disproportionately high burden on the healthcare system due to their elevated resource use. Identification of persistent HUs is pertinent as interventions have not been effective due to regression to the mean in majority of patients. This study will use cost and utilization metrics to segment a hospital-based patient population into HU groups. Methods The index visit for each adult patient to an Academic Medical Centre in Singapore during 2006 to 2012 was identified. Cost, length of stay (LOS) and number of specialist outpatient clinic (SOC) visits within 1 year following the index visit were extracted and aggregated. Patients were HUs if they exceeded the 90th percentile of any metric, and Non-HU otherwise. Seven different HU groups and a Non-HU group were constructed. The groups were described in terms of cost and utilization patterns, socio-demographic information, multi-morbidity scores and medical history. Logistic regression compared the groups’ persistence as a HU in any group into the subsequent year, adjusting for socio-demographic information and diagnosis history. Results A total of 388,162 patients above the age of 21 were included in the study. Cost-LOS-SOC HUs had the highest multi-morbidity and persistence into the second year. Common conditions among Cost-LOS and Cost-LOS-SOC HUs were cardiovascular disease, acute cerebrovascular disease and pneumonia, while most LOS and LOS-SOC HUs were diagnosed with at least one mental health condition. Regression analyses revealed that HUs across all groups were more likely to persist compared to Non-HUs, with stronger relationships seen in groups with high SOC utilization. Similar trends remained after further adjustment. Conclusion HUs of healthcare services are a diverse group and can be further segmented into different subgroups based on cost and utilization patterns. Segmentation by these metrics revealed differences in socio-demographic characteristics, disease profile and persistence. Most HUs did not persist in their high utilization, and high SOC users should be prioritized for further longitudinal analyses. Segmentation will enable policy makers to better identify the diverse needs of patients, detect gaps in current care and focus their efforts in delivering care relevant and tailored to each segment. Electronic supplementary material The online version of this article (10.1186/s12913-019-4239-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheryl Hui-Xian Ng
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nabilah Rahman
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Srinath Sridharan
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sravan Ramachandran
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Debby D Wang
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sue-Anne Toh
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Office, National University Health System, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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10
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Berry D, Street M, Considine J. Service use by older very frequent emergency department users: A retrospective cohort study. Australas Emerg Care 2019; 22:133-138. [PMID: 31196735 DOI: 10.1016/j.auec.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Frequent 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. METHODS A 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). RESULTS There 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). CONCLUSIONS Out-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.
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Affiliation(s)
- D Berry
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University - Eastern Health Partnership, Box Hill, Australia.
| | - M Street
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University - Eastern Health Partnership, Box Hill, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
| | - J Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University - Eastern Health Partnership, Box Hill, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
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