Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics

Blair, Mitch; Poots, Alan J; Lim, Vivien K. G.; Hiles, S; Greenfield, Geva; Crehan, Caroline; Kugler, B T; Boreham, Charlotte

doi:10.1136/archdischild-2016-311952

Cited by 11 publications

(14 citation statements)

References 22 publications

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“…Some insights gained from a single-site exploration of children who are frequent attenders indicated two large groups of children: those with acute illness on a background of underlying long-term or complex condition and those with minor self-limiting illness. Both of these may be amenable to further health and social care interventions 15…”

Section: Discussionmentioning

confidence: 99%

Frequent attendances at emergency departments in England

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Frequent attendances at emergency departments in England

et al. 2020

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“…A US study found that children with four or more ED presentations in 1 year represented only 8% of all ED patients but accounted for 25% of all presentations and 31% ($1.4 billion) of all costs. 4 Paediatric ED use has been lower in other countries with frequent presenters accounting for 2-6% of all paediatric ED patients, 3,5,6 and 20% of all ED presentations in Canada and the UK. 3,5 Lower ED use in countries outside of the USA could be explained by the way healthcare is organised, delivered and funded.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…4 Paediatric ED use has been lower in other countries with frequent presenters accounting for 2-6% of all paediatric ED patients, 3,5,6 and 20% of all ED presentations in Canada and the UK. 3,5 Lower ED use in countries outside of the USA could be explained by the way healthcare is organised, delivered and funded. The USA has no universal health-care coverage for its residents but other countries such as Australia, UK and Canada provide assorted combinations of public and private insurance programmes.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…To date researchers have identified that paediatric frequent ED presenters are more likely to be of ethnic minority, 4,5,8 publicly insured, 4,8 male 5,6,9 and of younger age. [3][4][5][6]8,10 Although chronic illness has been shown to be associated with frequent ED use in the adult population, this has not been a consistent finding in the paediatric population. 4,5,8,10,11 Research on socio-economic disadvantage and frequency of ED use has also produced mixed results.…”

Section: What This Paper Addsmentioning

confidence: 99%

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Characteristics of paediatric frequent presenters at emergency departments: A whole‐of‐population study

Procter

Gialamas

Pilkington

et al. 2020

J Paediatrics Child Health

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Aim To quantify the frequency of emergency department (ED) presentations and profile the socio‐demographic, health and presentation characteristics of paediatric ED frequent presenters. Methods A population‐based data linkage study of 55 921 children in the South Australian Early Childhood Data Project aged 0–12 years with 100 976 presentations to public hospital EDs in South Australia. For each child, the total number of recurrent ED presentations during a 364‐day period post‐index presentation was calculated. Frequent presenters were children who experienced ≥4 recurrent ED presentations. We determined the socio‐demographic, health and presentation characteristics by number of recurrent presentations. Results Children with ≥4 recurrent presentations (4.4%) accounted for 15.4% of all paediatric ED presentations and 22.5% of subsequent admissions to hospital during the 12‐month study period. Compared to children with no recurrent ED presentation, frequent presenters had higher proportions of socio‐economic and health disadvantage at birth. One in two (49.3%) frequent presenters had at least one injury presentation and one (21.3%) in five had at least one presentation related to a chronic condition. Conclusions Children with ≥4 presentations do not represent the majority of ED users. Nevertheless, they represent a disproportionate burden accounting for 15% of all paediatric ED presentations in a 12‐month period. Frequent presenters were characterised by early socio‐economic and health disadvantage, and childhood injury. Strategies targeting social disadvantage and childhood injury may reduce the burden of ED presentations.

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“…For national bodies, the first key recommendation is that, in future, quality measurement within NHS services for CYP should receive the same rigour and attention as within adult services. One example of this would be that appropriate validation and case-mix adjustment processes, which are routinely used for adult data, should be adapted and used for measures relating to CYP 27 28. Similarly, all relevant bodies should commit to working together and adopting a unified, evidence-based approach to quality measurement for CYP.…”

Section: Conclusion and Next Stepsmentioning

confidence: 99%