Frequent Emergency Department Users More Likely To Die Or Be Admitted Interview with:
Dr. Brian Rowe, MD, MSc, CCFP(EM), FCCP
Professor, Department of Emergency Medicine
University of Alberta, Edmonton, Alberta, Canada

MedicalResearch: What is the background for this study?

Dr. Rowe: Frequent users are also called “familiar faces” or “heavy users” and they represent an important sub-group of patients in the emergency setting, with often complex needs that contribute to overcrowding and excess health care costs. The evidence suggests that frequent users account for up to one in 12 patients seeking emergency care, and for around one in four of all visits.

MedicalResearch: What are the main findings?

Dr. Rowe: Frequent users of emergency department care are more than twice as likely to die, be admitted to hospital, or require other outpatient treatment as infrequent users, concludes an analysis of the available evidence, published in Emergency Medicine Journal.

These conclusions are based on a thorough search of seven electronic databases of relevant research relating to the frequency and outcomes of emergency department use by adults. Out of a total of more than 4000 potential studies, 31 relevant research reports published between 1990 and 2013 were included in the final analysis. Frequent users were variably defined as visiting emergency care departments from four or more times up to 20 times a year.

Among the seven studies looking at deaths, the analysis showed that frequent attenders at emergency care departments were more than twice as likely to die as those who rarely sought emergency care. Most of the studies included hospital admission as an outcome, and these showed that frequent users were around 2.5 times as likely to be admitted as infrequent users. Ten studies looked at use of other hospital outpatient care, and these showed that frequent users were more than 2.5 times as likely to require at least one outpatient clinic after their visit to the emergency care department.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Rowe: Our results suggest that, despite heterogeneity, frequent users are a distinct and high risk group. Clinicians should be aware of the important risks associated with this group of patients. Frequent users should not be discouraged from attending emergency departments; however, an organized care plan should be developed.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Rowe: The lack of any consensus as to what constitutes a frequent user is striking, and this makes it difficult to permit comparison and generate potentially generalizable recommendations. Proactive, targeted treatment may help patients and clinicians. Further research on these remaining issues is urgently required.


Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review

Jessica Moe, Scott Kirkland, Maria B Ospina, Sandy Campbell, Rebecca Long, Alan Davidson, Patrick Duke, Tomo Tamura, Lisa Trahan, Brian H Rowe

Emerg Med J emermed-2014-204496Published Online First: 7 May 2015 doi:10.1136/emermed-2014-204496

[wysija_form id=”3″] Interview with: Dr. Brian Rowe, MD, MSc, CCFP(EM), FCCP (2015). Frequent Emergency Department Users More Likely To Die Or Be Admitted

Last Updated on May 11, 2015 by Marie Benz MD FAAD