Visits by frequent users (FUs) has been suggested as one reason for crowding in emergency departments (EDs). In this article, we identified the characteristics of double frequent users (DFUs), ≥ 8 visits during 12 months in an ED during a period of six years, in one ED in Western Sweden. The primary outcome was to characterise DFUs and find common reasons for repeatedly visiting the ED. We conducted a retrospective cohort analysis on register data covering six years of all visits. The DFUs share of all visitors to the ED was not more than 0.03% (144 individuals), but their share of visits was 2.4% (1,017 visits/year). Chest pain and abdominal pain were the most common complaints. A typical DFU is male, around 50-year-old, unemployed, non-immigrant, suffering from alcohol abuse and/or mental health conditions. The results point to the need for changing strategies in ED services towards DFUs suffering from alcohol abuse and/or mental health conditions. The ED prioritises the severely ill but lacks resources and continuity for handling chronic diseases and follow-up routines.
The emergency department (ED) is one of the busiest facilities in a hospital, and it is frequently described as a bottleneck that limits space and structures, jeopardising surge capacity during Major Incidents and Disasters (MIDs) and pandemics such as the COVID 19 outbreak. One remedy to facilitate surge capacity is to establish an Urgent Care Centre (UCC), i.e., a secondary ED, co-located and in close collaboration with an ED. This study investigates the outcome of treatment in an ED versus a UCC in terms of length of stay (LOS), time to physician (TTP) and use of medical services. If it was possible to make these parameters equal to or even less than the ED, UCCs could be used as supplementary units to the ED, improving sustainability. The results show reduced waiting times at the UCC, both in terms of TTP and LOS. In conclusion, creating a primary care-like facility in close proximity to the hospitals may not only relieve overcrowding of the hospital’s ED in peacetime, but it may also provide an opportunity for use during MIDs and pandemics to facilitate the victims of the incident and society as a whole.
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