Predictors of frequent attenders of emergency department at an acute general hospital in Singapore

Paul, PraveenG; Heng, Bee Hoon; Seow, Eillyne; Molina, Joseph Antonio D; Tay, Seow Yian

doi:10.1136/emj.2009.079160

Cited by 46 publications

(50 citation statements)

References 17 publications

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“…25 However, they employed a different definition for frequent attenders (five or more visits over a 12-month period) and performed a univariate analysis with a different outcome of interest (ED reattendance, defined as the second visit at the ED for any diagnosis within 12 months after the initial visit). Our study results were found to agree in general, but in addition our study attempted to differentiate between appropriate and inappropriate visits and the true costs that are associated with these visits.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Boh

Finkelstein

et al. 2015

Academic Emergency Medicine

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Objectives: This study aimed to determine which factors contribute to frequent visits at the emergency department (ED) and what proportion were inappropriate in comparison with nonfrequent visits.Methods: This study was a retrospective, case-control study comparing a random sample of frequent attenders and nonfrequent attenders, with details of their ED visits recorded over a 12-month duration. Frequent attenders were defined as patients with four or more visits during the study period.Results: In comparison with nonfrequent attenders (median age = 45.0 years, interquartile range [IQR] = 28.0 to 61.0 years), frequent attenders were older (median = 57.5 years, IQR = 34.0 to 74.8 years; p = 0.0003). They were also found to have more comorbidities, where 53.3% of frequent attenders had three or more chronic illnesses compared to 14% of nonfrequent attenders (p < 0.0001), and were often triaged to higher priority (more severe) classes (frequent 52.2% vs. nonfrequent 37.6%, p = 0.0004). Social issues such as bad debts (12.7%), heavy drinking (3.3%), and substance abuse (2.7%) were very low in frequent attenders compared to Western studies. Frequent attenders had a similar rate of appropriate visits to the ED as nonfrequent attenders (55.2% vs. 48.1%, p = 0.0892), but were more often triaged to P1 priority triage class (6.7% vs. 3.2%, p = 0.0014) and were more often admitted for further management compared to nonfrequent attenders (47.5% vs. 29.6%, p < 0.001). The majority of frequent attender visits were appropriate (55.2%), and of these, 81.1% resulted in admission. For the same number of patients, total visits made by frequent attenders ($174,247.60) cost four times as much as for nonfrequent attenders ($40,912.40). This represents a significant economic burden on the health care system.Conclusions: ED frequent attenders in Singapore were associated with higher age and presence of multiple comorbidities rather than with social causes of ED use. Even in integrated health systems, repeat ED visits are frequent and expensive, despite minimal social causes of acute care. EDs in aging populations must anticipate the influx of vulnerable, elderly patients and have in place interventional programs to care for them.ACADEMIC EMERGENCY MEDICINE 2015;22:1025-1033 by the Society for Academic Emergency Medicine C are at the emergency department (ED) is usually focused on acutely ill patients facing life-threatening conditions. Worldwide, EDs have faced problems of overcrowding, long patient wait times, and admission bed blocks related to increasing numbers of patients.1-7 ED visits in Singapore's seven public hospiFrom the Duke-NUS Graduate

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Section: Discussionmentioning

confidence: 99%

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Boh

Finkelstein

et al. 2015

Academic Emergency Medicine

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“…Frequent use of hospital emergency departments (EDs) by specific patient subgroups has been reported in several countries, irrespective of the details of the health care system in use. [1][2][3][4][5][6][7][8] Frequent users are patients who use EDs on multiple occasions. Definitions and visit number thresholds vary across studies; according to Locker et al, 9 a frequency of more than 4 attendances per year corresponds to nonrandom events, and use of this threshold may improve comparisons between studies.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Interventions Targeting Frequent Users of Emergency Departments: A Systematic Review

Althaus

Paroz

Hügli

et al. 2011

Annals of Emergency Medicine

281

316

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Interventions targeting frequent users may reduce ED use. Case management, the most frequently described intervention, reduced ED costs and seemed to improve social and clinical outcomes. It appears to be beneficial to patients and justifiable for hospitals to implement case management for frequent users in the framework of a clear and consensual definition of frequent users and standardized outcome measures.

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“…The scientific literature suggests that demand for emergency department services has been increasing over recent decades in many geographic jurisdictions, including: Singapore [2], Spain [3] and the United States [4]. Changing preferences of medical consumers may be related to this increased demand for emergency health services.…”

Section: Introductionmentioning

confidence: 99%

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

et al. 2011

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BackgroundEmergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research.MethodsData regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic.ResultsThe CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely s...

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Predictors of frequent attenders of emergency department at an acute general hospital in Singapore

Cited by 46 publications

References 17 publications

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore

Effectiveness of Interventions Targeting Frequent Users of Emergency Departments: A Systematic Review

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

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