Emergency department study targets 'frequent flyers'

Wednesday, November 23, 2011


A new study has found that hospital emergency department 'frequent flyers' can be targeted through a range of mechanisms to reduce overcrowding and deliver more appropriate treatments.

"Frequent re-attendances at emergency contribute to emergency overcrowding and are a problem worldwide. Research in a range of countries indicates that frequent attenders are more likely to be from disadvantaged groups and are older, male and non-white ethnic background," said lead researcher, Sue Kirby, from the Research Centre for Primary Health Care and Equity, University of NSW.

"The aim of this study was to identify patient characteristics associated with frequent re-attendances to develop solutions to prevent their occurrence. We carried out a retrospective analysis of 2008 data from the emergency department collected at a 150 bed regional hospital in south-eastern Australia. All patient data were de-identified. The hospital, funded by the State and Commonwealth Governments, has a feeder population of around 100 000.

"Our analysis found that older people were more likely to be frequent re-attenders, which is in line with other work and supports the notion that older people, by virtue of their age, are more likely to have developed conditions requiring treatment.

"In contrast to other work reporting more men than women are frequent re-attenders, we found no sex difference in this study. Other studies reported that ethnic non-Caucasian patients are more likely to be frequent re-attenders whereas we found no significant difference between Australian born and non-Australian born patients after adjustment for confounding factors.
"Unplanned return visits for the same condition within 28 days was the strongest predictor of frequent re-attendance. Patients could return to the emergency department because they had difficulty accessing primary care services or because the original problem required extra emergency treatment.

"Data analysis showed that most conditions associated with frequently re-presenting patients are suitable for treatment outside the hospital setting. Given the ever-increasing problem of emergency utilisation, we recommend that alternative services options be considered by governments and policy makers. Possible solutions include supported referral of patients with chronic conditions to appropriate self-management services; improved access to mental health services in the community and accessible clinic services for minor conditions such as follow-up examinations, sutures and dressing and repeat prescriptions outside the emergency department.

"By targeting the specific needs of ED re-attenders through the provision of more appropriate and cost-effective community-based services we can reduce over crowding in hospitals, save scarce health resources and increase access to care for consumers," Ms Kirby said.

For more information and comment: Sue Kirby 0407 450 532