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The chronic emergency department patient
Insights
Frequent emergency department (ED) visitors are often single men with alcoholism and chronic psychiatric conditions. Addressing their complex needs can save significant healthcare resources.
Area of Science:
- Emergency Medicine
- Public Health
- Psychiatry
Background:
- Frequent emergency department (ED) visits represent a significant, yet understudied, healthcare challenge.
- Chronic ED visitors often present with complex psychosocial and medical comorbidities.
- Understanding the characteristics of this patient population is crucial for effective resource allocation.
Purpose of the Study:
- To characterize the demographic, socioeconomic, and clinical profiles of frequent ED visitors.
- To identify the primary reasons for frequent ED utilization.
- To explore potential strategies for diverting these patients to more appropriate care settings.
Main Methods:
- A retrospective chart review was conducted to identify frequent ED visitors.
- The criterion for frequent visitation was defined as one or more visits per month over a six-month period.
- Data collected included demographics, diagnoses, social support, mode of transport, and disposition.
Main Results:
- A cohort of 16 frequent ED visitors was identified, predominantly single men (81% male, 94% single) with an average age of 48.5 years.
- High prevalence of alcoholism (87.5%) and chronic psychiatric conditions (56%) was observed.
- Most patients relied on government support (75%), lived alone (69%), and arrived via ambulance (84%), with low hospital admission rates (6%).
Conclusions:
- Chronic ED visitors often require ED services due to untreated alcoholism or mental illness, preventing adherence to other therapeutic programs.
- This population is at high risk for medical and traumatic illnesses, necessitating careful medical evaluation.
- Diversion to alternative care settings can lead to substantial savings in medical time and expense.
Abstract:
The chronic emergency department visitor presents a common but largely unstudied problem. Using the criterion of one or more visits per month for a six-month period, a population of 16 frequent or chronic visitors was identified at our institution. These chronic visitors were predominantly single (94%), men (81%), with an average age of 48.5 years. Alcoholism was present in 87.5% and 56% were suffering from a chronic psychiatric condition. The majority were dependent on government support (75%) and lived alone (69%). Ambulance transport was used for 84% of the visits, but in only 6% of the visits was hospital admission required. We concluded that these patients became the responsibility of the ED by default because alcoholism or mental illness prevented their compliance with any therapeutic program. Furthermore, this group is at high risk for medical and traumatic illness, and the physician must not let familiarity lead to careless evaluation. Several suggestions for disposition are provided, for the diversion of one such patient to an alternate and more appropriate source of care creates enormous savings in medical time and expense.