Smoking, Addiction and Mental Health Issues Linked To Frequent Emergency Department Visit

Jessica Castner, PhD, RN, CEN Assistant Professor University at Buffalo, New Interview with:
Jessica Castner, PhD, RN, CEN
Assistant Professor
University at Buffalo, New York

Medical Research: What is the background for this study?

Dr. Castner: There are groups of people more likely to visit the emergency department (ED) frequently.  One of these groups are people insured by Medicaid, the insurance for those with low incomes.  By finding what factors increase the risk for frequent emergency department use, healthcare leaders can target interventions to design a more effective and accessible healthcare delivery system.  With approximately 12 million ED visits each year related to behavioral health issues, we wanted to investigate how smoking, substance abuse and psychiatric diagnoses increased the risk for repeat ED use for adults insured by Medicaid.

There are many problems associated with frequent emergency department use, including less than ideal continuity of care, crowding, and cost. Every year, there are over 136 million visits to United States EDs, and 12 million are linked to some sort of behavioral health issue.  Unlike primary care, the patient is not likely to see a healthcare provider in the emergency department who knows them or one who may not have access to their complete and up-to-date records.  The patient might get conflicting guidance or have tests ordered that duplicate tests recently done in other settings.

Frequent emergency department visitors also contribute to crowded EDs, where demand outstrips capacity. Studies have shown an association with increased morbidity and mortality for patients treated in the ED during these times of crowding.

Medical Research: What are the main findings?

Dr. Castner: The main findings of our study include helping to dispel the myth of “inappropriate emergency department use.”  Our research analyzed the 2009 Medicaid claims for Erie and Niagara County. Our findings indicate that there is a positive relationship between outpatient visits and frequent emergency department use.  In other words, people who are sicker and have more complex illnesses use all services more – both the emergency department and their outpatient care provider.  In addition, we found that smoking, substance abuse, and psychiatric diagnoses all substantially increased the odds of frequent emergency department use – or ED bouncebacks.  The most surprising finding was that healthy individuals were four times more likely to be frequent ED users if they smoked.

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

Dr. Castner: Our findings continue to justify the need for targeted interventions for individuals who smoke, those who use or abuse substances, and those with psychiatric diagnoses to reduce frequent treat and-release emergency department use.  Brief screening interventions and referrals from the emergency department and community care coordination are essential for these populations.

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

Dr. Castner: Continued study of additional social variables known to influence emergency department use should be included, such as health literacy, homelessness, social support, or medication use.  Additional diagnoses and more detailed analysis of different types of substance abuse or psychiatric diagnoses should continue to be studied.  Frequent ED use for specific illnesses, such as pulmonary or cardiac disease may offer additional insights into the need for preventive services.


Nurs Res. 2015 Jan-Feb;64(1):3-12. doi: 10.1097/NNR.0000000000000065.

Frequent emergency department utilization and behavioral health diagnoses.

Castner J1, Wu YW, Mehrok N, Gadre A, Hewner S.

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Jessica Castner, PhD, RN, CEN, Assistant Professor, & University at Buffalo, New York (2015). Smoking, Addiction and Mental Health Issues Linked To Frequent Emergency Department Visit 

Last Updated on May 29, 2015 by Marie Benz MD FAAD