Frequent attendances at emergency departments in England

Abstract

BackgroundA small proportion of patients referred to as ‘frequent attenders’ account for a large proportion of hospital activity such as ED attendances and admissions. There is a lack of recent, national estimates of the volume of frequent ED attenders. We aimed to estimate the volume and age distribution of frequent ED attenders in English hospitals.MethodWe included all attendances at all major EDs across England in the financial year 2016–2017. Patients who attended three times or more were classified as frequent attenders. We used a logistic regression model to predict the odds of being a frequent attender by age group.Results14 829 519 attendances were made by 10 062 847 patients who attended at least once. 73.5% of ED attenders attended once and accounted for 49.8% of the total ED attendances. 9.5% of ED attenders attended three times or more; they accounted for 27.1% of the ED attendances. While only 1.2% attended six times or more, their contribution was 7.6% of the total attendances. Infants and adults aged over 80 years were significantly more likely to be frequent attenders than adults aged 30–59 years (OR=2.11, 95% CI 2.09 to 2.13, OR=2.22, 95% CI 2.20 to 2.23, respectively). The likelihood of hospital admission rose steeply with the number of attendances a patient had.ConclusionOne in 10 patients attending the ED are frequent attenders and account for over a quarter of attendances. Emergency care systems should consider better ways of reorganising health services to meet the needs of patients who attend EDs frequently.

Characteristics of frequently attending children in hospital emergency departments: a systematic review

“…Pressures on emergency health services are contributed to by a small group of individuals who attend EDs frequently, often referred to in the literature as ‘Frequent attenders’. 4 5 For example, in Singapore, the total visits made by frequent users cost four times as much as for non-frequent users, representing a significant economic burden. 6 For example, in England, young children, along with the elderly, are the group with the highest number of frequent attendances.…”

“… 6 For example, in England, young children, along with the elderly, are the group with the highest number of frequent attendances. 7 Children under 5 years old, while being 5.7% of the population, 8 account for 25.1% of all frequent attenders. 7 Frequent attendance behaviour could be influenced by the emergency care models in each country, as well as the general healthcare system model and cultural differences between countries, however, there are some commodities among frequent attending patients identified in the literature.…”

A comparison of Emergency Department presentations for Medically Unexplained Symptoms in Frequent Attenders during COVID-19

“…This issue is key for two reasons: the personal burden for patients, and the disproportionate use of allocated resources by the FA group. [5,6] Our primary aim was to compare the proportion of FA with MUS amongst all ED attendances during the first four months of the COVID-19 pandemic compared to a control period in 2019. The secondary aim was to compare the relative frequency of MUS diagnostic categories between the two periods.…”

“…This issue is key for two reasons: the personal burden for patients, and the disproportionate use of allocated resources by the FA group. [5,6]…”

A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19

“…5 As well as the personal burden for patients, there is a disproportionate use of healthcare resources by FAs. 6,7 Patients attend frequently as despite being reassured their condition is not a myocardial infarction, pulmonary embolism, seizure or similarly serious diagnosis, they are not given an adequate explanation for their symptoms. Their repeated attendance may lead clinicians to undertake further investigation, thus adding to cost and increasing the patient's dependence on the health service as well as their risk of iatrogenic harm.…”