Those who use emergency department services frequently are not time-wasters, according to a new study, but are actually at higher risk for death.
There are more than 136 million emergency department (ED) visits in the United States each year, according to the Centers for Disease Control and Prevention. The researchers in this new study defined a frequent user as someone who visits an emergency department between four and 20 times a year.
In the background literature for this study, published online in the Emergency Medicine Journal (EMJ), the authors note that frequent users account for only 4.5 to 8 percent of all ED patients, yet they account for 21 to 28 percent of all ED visits.
This research summarizes the findings of multiple U.S. and international studies to compare mortality and health service outcomes between those who use the emergency department frequently and those who do not. Specifically, the scientists investigated death rates, hospital admissions and the need for outpatient care in subjects defined as frequent ED users.
The researchers studied death rates of frequent ED users across seven studies examining mortality, and frequent visitors had a 2.2 times higher risk for mortality in comparison with those who did not visit the ED frequently.
The scientists also reviewed 28 studies assessing hospital admissions and found that frequent users were about 2.5 times more likely to be admitted to the hospital than patients who rarely use the ED. Ten studies showed that frequent ED users are also more than twice as likely to require outpatient treatment.
The study shows that risks are higher for frequent ED users, but the research does not explain why this occurs. It is possible that frequent ED users often have unmet needs, which puts them in greater need of medical attention.
Many frequent ED users suffer from comorbidities and other problems, including:
- Mental health issues
- Addiction
- Homelessness or an unstable living environment
- Chronic diseases, such as heart failure and COPD
- Comorbidities that require care, including cellulitis/abscess treatment, missed diagnoses and complications
The American College of Emergency Physicians agrees, saying that most frequent ED users have serious medical conditions treatable only in an ED. Emergency departments serve as a safety net for everyone, especially the most vulnerable patients who are likely to become frequent users.
Unfortunately, many believe that frequent users cause overcrowding and lengthy wait times in EDs. Others worry that frequent users run up the overall cost of emergency care. While ER physicians and nurses are dedicated to providing care to each patient at every visit, policymakers often look to reducing ED use as a way to decrease medical costs.
"Clearly, to view frequent users as merely a nuisance or drain on resources represents a narrow, biased and potentially dangerous view of this issue," the authors of the study wrote. "Our findings suggest that frequent ED users merit focused attention, continued research and implementation of interventions designed to meet their unmet needs from practitioners, health administrators and policymakers."
