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Researchers find patients who frequent ED have higher mortality, outpatient visits

Patients who frequent the emergency department repeatedly have higher mortality rates and a greater number of hospital admissions and outpatient visits, compared with non-frequent ED users, according to recently published data.

“Our results suggest that, despite heterogeneity, frequent users are a distinct and high risk group. Depending on the definition employed, they may include subgroups of patients with mental health and addiction issues, homelessness or unstable housing, chronic diseases … and patients who make frequent visits with conditions that may require transient increased needs. Based on the available evidence, frequent users appear to be at increased risk of death, admissions per visit, admissions per patient and outpatient visits,” the researchers wrote.

To assess the correlation between frequent emergency department (ED) use and mortality, hospital admissions and outpatient visits, researchers performed a systematic review of 31 studies gathered from seven electronic databases.

Varying definitions were used across studies to describe a ‘frequent’ visitor, ranging from a patient who visited the ED four times/year to a patient who visited more than 20 times/year.

Seven studies examined mortality rates of ED visitors, and results demonstrated that frequent visitors had a median 2.2 fold increased risk of mortality, compared with patients who were not frequent ED users.

In 28 studies, frequent ED users had increased odds of admission of 1.16 per visit and of admissions per patient of 2.58.

Ten studies showed odds of having an outpatient visit, post-ED visit increased 2.65-fold among frequent ED users.

The researchers noted that standardizing the definition of frequent visitors is imperative to help determine who is frequently visiting the ED, why they are frequenting and what interventions may best suit their needs.

“The heterogeneity in the literature on frequent users is striking; there is an urgent need to adopt standard definitions to allow comparable research and potentially generalizable recommendations. Future research should focus on identified subgroups (eg, mental health, chronic disease), interventions to reduce frequent visits and local frequent ED populations in order to understand site-specific needs and interventions,” the researchers wrote. – by Casey Hower

Disclosures: Moe reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.