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Stanford D, Dinh MM, Eastwood JG, Korczak V, Seimon RV, Moore C, Liu H, Bein KJ. Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis. Emerg Med Australas 2024; 36:277-282. [PMID: 38172087 DOI: 10.1111/1742-6723.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/21/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. METHODS A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365-day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non-MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. RESULTS Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio-Economic Advantage and Disadvantage. CONCLUSION Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
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Affiliation(s)
- Dorota Stanford
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John G Eastwood
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Viola Korczak
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Corey Moore
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hueiming Liu
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
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