The chronic emergency department patient

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.