Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns

Abstract

Introduction: The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. Methods: We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. Results: We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. Conclusion: A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden. Keywords: ED overcrowding, ED reattendance, emergency medicine, frequent attenders, frequent flyers, multiple emergency department attendance

Frequent attenders to multiple emergency departments in Singapore

“…4 Although numerous papers have been published from single-centre EDs to better understand the characteristics of these patients, several statewide studies highlighted the possibility for underestimation of the magnitude of the problem as FAs may have the propensity to visit multiple EDs in the same region.In this issue of the Annals, Pek et al characterised FAs at multiple Singapore public hospital EDs and compared them to those who only attend a single ED frequently. 5 The authors benefited from Singapore being an island nation, which enabled a retrospective analysis of nationwide ED de-identified electronic health database between 2006 and 2018. This is the longest longitudinal study on FAs in Singapore conducted thus far from a large database.…”

“…In this issue of the Annals, Pek et al characterised FAs at multiple Singapore public hospital EDs and compared them to those who only attend a single ED frequently. 5 The authors benefited from Singapore being an island nation, which enabled a retrospective analysis of nationwide ED de-identified electronic health database between 2006 and 2018. This is the longest longitudinal study on FAs in Singapore conducted thus far from a large database.…”

“…For instance, FAs to multiple EDs in England were older and more likely to be admitted compared to Singapore. 8 Nevertheless, regions with similar electronic database capabilities could model after Pek et al 5 and perform suitable analyses to comprehend patterns of their own FAs. After identifying attendance patterns, qualitative studies may be carried out to better understand the clinical, psychological and social profiles of these patients to ascertain if they are psychosocially vulnerable and heavily utilise other primary care services.…”