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Hyper-use of the ED.
Joseph R Shiber1, Michael B Longley, Kori L Brewer
1Department of Emergency Medicine, University of Central Florida, Orlando, FL 32803, USA. shiberj@bellsouth.net
The American Journal of Emergency Medicine
|June 6, 2009
Summary
Older patients with a history of cardiovascular, genitourinary, or psychiatric conditions frequently use emergency departments (EDs). These hyper-users (HU) show similar access to primary medical doctors (PMDs) compared to general ED populations.
Area of Science:
- Emergency Medicine
- Health Services Research
- Patient Demographics
Background:
- High-frequency emergency department (ED) utilization, defined as one or more visits per month, represents a significant burden on healthcare resources.
- Understanding the characteristics of patients with frequent ED visits is crucial for developing targeted interventions and improving healthcare delivery.
- This study focuses on identifying the distinct demographic and clinical profiles of hyper-users (HU) within the ED population.
Purpose of the Study:
- To characterize the population exhibiting hyper-use of emergency department (ED) services (averaging ≥1 visit/month).
- To compare this hyper-user (HU) cohort with the general ED population.
- To identify specific characteristics associated with hyper-utilization of EDs.
Main Methods:
- Retrospective cohort study conducted at a teaching hospital from January 2001 to December 2004.
- Identified a hyper-user (HU) cohort (n=49) with >35 visits and compared them to a randomly selected non-HU cohort (n=50).
- Compared cohorts based on age, sex, insurance, primary medical doctor (PMD) access, dwelling location, chief complaint, comorbidities, and disposition.
Main Results:
- The HU cohort was significantly older (mean age 49.45 years) than the non-HU cohort (mean age 37.32 years; P < .0001).
- No significant differences were observed in sex, insurance coverage, PMD access, dwelling location, or disposition between the HU and non-HU groups.
- Univariate logistic regression identified prior cardiovascular, genitourinary, or psychiatric diseases as predictors of hyper-use.
Conclusions:
- Hyper-users (HU) of emergency departments are older and more likely to have a history of cardiovascular, genitourinary, and psychiatric conditions.
- Despite frequent ED visits, HU patients demonstrated similar access to primary medical doctors (PMDs) and hospital admission rates compared to non-HU patients.
- These findings suggest that targeted interventions for specific comorbidities may help reduce ED hyper-utilization.
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