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Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis
Jessica Moe1, Fiona O'Sullivan2, Margaret J McGregor2
1Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC jessica.moe@ubc.ca.
Insights
Frequent emergency department use is rising, driven by a diverse group of patients. Interventions must address the varied reasons for frequent visits and consider patient heterogeneity.
Area of Science:
- Health Services Research
- Public Health
- Healthcare Economics
Background:
- Frequent emergency department (ED) use significantly contributes to escalating healthcare expenditures.
- Understanding the characteristics of frequent ED users is crucial for cost containment and resource allocation.
Purpose of the Study:
- To characterize frequent emergency department users in British Columbia, Canada.
- To identify demographic, clinical, and healthcare utilization patterns associated with frequent ED visits.
Main Methods:
- Retrospective analysis of health administrative data from 2012/13 to 2015/16.
- Inclusion of patients aged 18+ with at least one ED visit, linked to hospital, physician billing, prescription, and mortality data.
- Definition of frequent users as the top 10% of patients with ≥ 3 ED visits annually.
Main Results:
- Frequent ED users constituted 13.8%-15.3% of patients, accounting for 40.3% of total visits in 2015/16.
- Visit rates among frequent users increased by 21.8% from 2012/13 to 2015/16.
- Frequent users were older, had lower incomes, higher prescription rates, more primary care visits, more hospital admissions, and higher 1-year mortality (10.2%) compared to non-frequent users.
Conclusions:
- Emergency department use by frequent users in British Columbia increased significantly between 2012/13 and 2015/16.
- Frequent ED users are a heterogeneous population with high mortality rates, and few remain frequent users over multiple years.
- Interventions should acknowledge this heterogeneity and target the underlying triggers of frequent ED use episodes.
Background:
Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada.
Methods:
We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year).
Results:
Over the study period, 13.8%-15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5-14 v. 1, IQR 1-3), primary care visits (median 15, IQR 9-27 v. 7, IQR 4-12) and hospital admissions (median 2, IQR 1-3 v. 1, IQR 1-1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users.
Interpretation:
Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.
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