Frequent Users of Emergency Departments: Developing Standard Definitions and Defining Prominent Risk Factors

Doupe, Malcolm; Palatnick, Wes; Day, Suzanne; Château, Dan; Soodeen, Ruth-Ann; Burchill, Charles; Derksen, Shelley

doi:10.1016/j.annemergmed.2011.11.036

Cited by 215 publications

(245 citation statements)

References 41 publications

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“…14 In addition, elderly populations may be different than other adult users, with higher numbers of EMS activations due to falls, and distinct nontransport rates. 20 Although the Tangherlini et al study focused only on elderly users, their data parallel the ED literature on highly frequent users, 8 suggesting that closer examination of this group may identify a unique, high-cost, very frequent use population amenable to intervention.…”

Section: Introductionmentioning

confidence: 56%

“…These results are similar to those found in recent studies of ED "very high users" (≥18 visits), who also tend to be middle-aged and are characterized by a high prevalence of drug and alcohol use. 8,25 Drug and alcohol use has been repeatedly shown to be strongly associated with frequent use of services in a variety of emergency settings. 8,11,22,[26][27][28][29] Thus, the disproportionately high alcohol involvement in EMS superusers is not surprising.…”

Section: Discussionmentioning

confidence: 99%

“…8,25 Drug and alcohol use has been repeatedly shown to be strongly associated with frequent use of services in a variety of emergency settings. 8,11,22,[26][27][28][29] Thus, the disproportionately high alcohol involvement in EMS superusers is not surprising. However, our study provides empirical evidence that alcohol involvement increases exponentially in moderate-use, high-use, and superuser EMS groups when compared to the low-use group, suggesting that superusers have distinct characteristics and health-care demands.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 As such, considerable attention is being turned toward frequent users of EDs and EMS systems in the lay media as well as the scientific community. [4][5][6][7][8][9][10][11][12][13][14] Using a definition of greater than 4 ED visits per year, adult frequent ED users are known to require more ED resources, have a greater length of stay, and have greater morbidity than those who do not use the ED frequently. 5,9,[13][14][15][16] However, literature regarding frequent EMS users is far more limited, and focuses on small numbers of patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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Section: Introductionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

View full text Add to dashboard Cite

show abstract

“…Our results may have been influenced by the fact that despite our use of a validated definition, 1 most participants had only 5-6 visits at enrollment, and CM may be of greater benefit for those with higher baseline ED use, given the increased vulnerability of this group. 12,42 Furthermore, over one-third of participants were from Africa, Latin America or Asia, regions of origin common for asylum seekers, refugees or undocumented immigrants living in Switzerland. The limited primary care services in these regions 43 may have led to increased ED use among these participants.…”

Section: Discussionmentioning

confidence: 99%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention--compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

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Emergency health service contact and reincarceration after release from prison: A prospective cohort study

Andrade

Spittal

Snow

et al. 2019

Criminal Behav Ment Health

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Background Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned. Aims/hypotheses To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk. Methods Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24‐hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates. Results More than half (53.3%) of participants had at least one EHS contact over a median of 25.6‐month follow‐up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio [HR] = 1.84; 95% confidence interval [CI] [1.48, 2.29]) or four or more (HR = 2.35; 95% CI [1.67, 3.29]). Conclusions/implications for practice Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration.

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Frequent Users of Emergency Departments: Developing Standard Definitions and Defining Prominent Risk Factors

Cited by 215 publications

References 41 publications

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

Emergency health service contact and reincarceration after release from prison: A prospective cohort study

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