Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy

Abstract

BackgroundFrequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs.MethodsThe analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors.ResultsA total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001).ConclusionThe FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of FUs.

Why patients self-refer to the emergency service for nonurgency?: A mix-method survey from a family medicine perspective

“…In a systemic review, the findings were inconsistent among 10 articles that examined gender. [ 1 , 21 ] Similarly, our study did not find a significant difference between FP knowledge and preference for ES according to sex.…”

“…In other studies, the average age of self-referred patients was <40 years. [ 15 , 21 , 22 ] Older adults tend to have more urgent medical visits than younger adults. [ 1 ] The mean patient age was 34 years.…”

Limitations and consequences of public health models centred on hospitals and lacking connections with territorial and home-based social and health services

“…A significant proportion of these admissions are certainly inappropriate and associated with pathologies that can be managed by facilities and health services outside the hospital setting by improving the efficiency of the hospital services provided [ 17 , 18 ]. As early as the 1980s, the profile of FU patients who accessed the ED because of medical and psychosocial problems was studied.…”

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

“…This allows for an optimal and futuristic model of healthcare, in which medical actors have the possibility to establish a personal bond with patients through multiple daily visits, taking full responsibility for the critical health conditions with which they were required to intervene [ 44 ]. This is extremely important in the management of chronic conditions, which often involves the inappropriate usage of emergency services for pathologies that, if well managed, could be treated in settings outside of the hospital [ 45 ].…”