People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study

Abstract

Background:The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. Methods:This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health-related hospitalization data. Results:We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol-and substance use-related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. Interpretation: Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

“…For instance, interventions like case management have been shown to reduce numbers of ED visits, and may produce overall cost savings [ 48 , 49 ]. Substance and alcohol use presentations are among the factors associated with chronic high ED utilization among people with frequent ED visits, highlighting the clinical importance of the overlap between these two populations [ 50 , 51 ]. Increasing recognition of multiple factors associated with long-term frequent ED utilization (e.g., substance use, homelessness, mental health issues) suggest that screening interventions could enable the early detection of patients at risk and the initiation of preventative interventions that address underlying unmet needs driving high utilization [ 50 , 51 ].…”

“…Substance and alcohol use presentations are among the factors associated with chronic high ED utilization among people with frequent ED visits, highlighting the clinical importance of the overlap between these two populations [ 50 , 51 ]. Increasing recognition of multiple factors associated with long-term frequent ED utilization (e.g., substance use, homelessness, mental health issues) suggest that screening interventions could enable the early detection of patients at risk and the initiation of preventative interventions that address underlying unmet needs driving high utilization [ 50 , 51 ]. ED visits may be the optimal points of healthcare contact to engage patients with harmful substance use in preventive intervention, and these opportunities are not always recognized [ 52 ].…”

Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care

“…High ED users have historically been targeted to reduce ED overcrowding and associated high costs [3]. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use [4], which is usually defined as 4+ ED visits/year-a standard benchmark often used, especially in Canadian studies [4,5]. Across Canada, there is a rising trend in both the overall number of ED visits and visits linked to high ED users [5].…”

“…Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use [4], which is usually defined as 4+ ED visits/year-a standard benchmark often used, especially in Canadian studies [4,5]. Across Canada, there is a rising trend in both the overall number of ED visits and visits linked to high ED users [5]. A Quebec study has shown that in 2014-2015, patients with psychiatric disorders used EDs almost twice as often as patients without psychiatric disorders, and 17% of them were high ED users who accounted for close to half of all ED use and hospitalizations [6].…”

Identifying facilitators and barriers to integrated and equitable care for community-dwelling older adults with high emergency department use from historically marginalized groups

“…Emergency department (ED) visits have been shown to be a good proxy of health and social services usage [ 23 ]. Canadians, in general, appear to use EDs more frequently than people in other Commonwealth countries [ 24 ] and, in many jurisdictions, the number of emergency department visits attributable to frequent users is increasing [ 25 ]. Patients with complex care needs have particularly high utilization rates of episodic care [ 26 ].…”