Unique characteristics of frequent presenters to the emergency department in a Japanese population: a retrospective analysis

Abstract

Aim Little evidence on Japanese frequent presenters (FPs) is available. Therefore, this retrospective cohort study compared characteristics between FPs and non‐frequent presenters (NFPs) in emergency departments (EDs) in Japan. Methods Frequent presenters included those who presented to an ED ≥4 times during the study period from August 1, 2012 to July 21, 2013. The primary outcomes were triage level and disposition. Secondary outcomes were ED length of stay, method of arrival, and discharge diagnosis. Results During the study period, 195 FPs had 1,154 visits to the ED, compared to 15,953 visits by 13,838 NFPs. The sex distribution between FPs and NFPs was comparable (107 men [54.9%] versus 7,070 men [51.1%], respectively; P = 0.29), but the mean age was significantly higher in the FP group (57.3 versus 46.5 years, respectively; P < 0.0001). Among the FPs, the rate of free governmental health insurance was higher than that of those who pay 30% of health costs (35 patients paid 0% [79.5%] versus 109 patients paid 30% [42.6%], respectively). Condition severity (FP, 84 severe cases [7.28%]; NFP, 1,320 severe cases [8.27%], respectively) and rate of admission (FP, 207 admissions [17.9%]; NFP, 2,987 admissions [18.7%], respectively) were comparable between the groups, although the rate of ambulance use was lower for the FP group. The most frequent diagnostic codes (International Classification of Diseases, 10th Revision) in the FP group were “symptoms and signs”. Conclusion Triage levels and hospital admission rates were not significantly different between FPs and NFPs in this single‐center study in Japan.

Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study

“…In the previous study conducted in Japan, mental health issues were not related to frequent ED visits but this may be attributable to the absence of full-time psychiatric providers in that hospital. 11 While a difference was noted in the proportion of frequent ED visits for paediatric problems between the secondary and tertiary hospital, this finding was not surprising given the lack of a full-time paediatrician in the secondary hospital in our study. Because characteristics of frequent ED users are heterogeneous, 7 analysis of characteristics of frequent ED users in each hospital is important to reduce frequent ED visits.…”

“…These findings contrast with the previous Japanese study conducted near Tokyo where 1.39% frequent ED users (≥4 visits/year) occupied 6.75% of all ED visits and the previous study did not report the used healthcare expenditures. 11 The differences may be attributable to a different setting as the latter is from an ED in a single tertiary hospital serving a population of 170 000 near metropolitan Tokyo. Because this tertiary hospital was located near a metropolitan area, the patients might visit the hospital from a wider range of areas compared with the present study’s setting.…”

“…For example, in the study by Takeuchi et al, they found frequent ED users comprised 1.4% of all ED users and occupied 6.8% of all ED visits. 11 Frequent ED users were older and more often receiving governmental welfare in comparison with non-frequent ED users. 11 As the number of ED visits by ambulances has been annually increasing by 72 thousand per year in Japan, 13 a better understanding of the patterns and costs associated with frequent ED users in Japan would be indispensable for developing interventions to reduce unnecessary visit burdens on EDs and mitigate unnecessary costs.…”

“…In Japan, research on frequent ED users has been investigated in single-centre studies. 11 12 Also, there is no research about healthcare expenditure of frequent ED users in Japan. For example, in the study by Takeuchi et al , they found frequent ED users comprised 1.4% of all ED users and occupied 6.8% of all ED visits.…”

Association between Public Assistance and Frequent Emergency Department Visits in Urban Areas of Japan: A Case-Control Study

“…In Japan, studies have focused on specific conditions, such as bronchial asthma and psychiatric disorders, but there are few studies regarding the association of other factors and ED visitation frequency. A study by Takeuchi et al indicated that patients receiving public medical assistance had a higher risk of frequently visiting the ED than did patients using regular medical insurance in Japan 11 , but that study did not take age or underlying conditions into account.…”