Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 42-48 , July 2010

Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications

  • Eduardo LaCalle, MD, MPH

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Eduardo LaCalle, MD, MPH, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029; 212-659-1660, fax 212-426-1946
    • ,
  • Elaine Rabin, MD

Received 27 September 2009 ,Revised 27 January 2010 ,Accepted 29 January 2010.

References 

  1. Pitts SR, Niska R, Xu J, et al. National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. Hyattsville, MD: National Center for Health Statistics; 2008;
  2. Arnst C. McCain health-care proposal. Business Week. April 29, 2008;http://www.businessweek.com/bwdaily/dnflash/content/apr2008/db20080429_854428.htmAccessed December 17, 2009
  3. Obama B. Remarks by the president to a joint session of Congress on health care, September 9, 2009; US Capitol, Washington, DC. http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-CareAccessed December 17, 2009
  4. Abelson R. Uninsured put a strain on hospitals. The New York Times. December 8, 2008;B1
  5. Jamieson D. The treatment of Kenny Farnsworth. Washington Post. November 11, 2009;Magazine W12
  6. Quinones S. Saving the ER for real emergencies: costly “frequent fliers” are being encouraged to visit clinics in LA. Los Angeles Times. January 22, 2007;A.1
  7. Counsell C. Formatting questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med. 1997;127:380–387
  8. Baillargeon J, Thomas CR, Williams B, et al. Medical emergency department utilization patterns among uninsured patients with psychiatric disorders. Psychiatr Serv. 2008;59:808–811
  9. Belcher JV, Alexy B. High-resource hospital users in an integrated delivery system. J Nurs Adm. 1999;29:30–36
  10. Blank FS, Li H, Henneman PL, et al. A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs. 2005;31:139–144
  11. Curran GM, Sullivan G, Williams K, et al. The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study. BMC Emerg Med. 2008;8:17
  12. Ford JG, Meyer IH, Sternfels P, et al. Patterns and predictors of asthma-related emergency department use in Harlem. Chest. 2001;120:1129–1135
  13. LeDuc K, Rosebrook H, Rannie M, et al. Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors. J Emerg Nurs. 2006;32:131–138
  14. Lucas RH, Sanford SM. An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med. 1998;32:563–568
  15. Mandelberg JH, Kuhn RE, Kohn MA. Epidemiologic analysis of an urban, public emergency department's frequent users. Acad Emerg Med. 2000;7:637–646
  16. Milbrett P, Halm M. Characteristics and predictors of frequent utilization of emergency services. J Emerg Nurs. 2009;35:191–198
  17. Rask KJ, Williams MV, McNagny SE, et al. Ambulatory health care use by patients in a public hospital emergency department. J Gen Intern Med. 1998;13:614–620
  18. Riggs JE, Davis SM, Hobbs GR, et al. Association between early returns and frequent ED visits at a rural academic medical center. Am J Emerg Med. 2003;21:30–31
  19. Ruger JP, Richter CJ, Spitznagel EL, et al. Analysis of costs, length of stay, and utilization of emergency department services by frequent users: implications for health policy. Acad Emerg Med. 2004;11:1311–1317
  20. Sandoval E, Smith S, Walter J, et al. A comparison of frequent and infrequent visitors to an urban emergency department. J Emerg Med. 2008;38:115–121
  21. Yamamoto LG, Zimmerman KR, Butts RJ, et al. Characteristics of frequent pediatric emergency department users. Pediatr Emerg Care. 1995;11:340–346
  22. Cook LJ, Knight S, Junkins EP, et al. Repeat patients to the emergency department in a statewide database. Acad Emerg Med. 2004;11:256–263
  23. Freitag FG, Kozma CM, Slaton T, et al. Characterization and prediction of emergency department use in chronic daily headache patients. Headache. 2005;45:891–898
  24. Friedman BW, Serrano D, Reed M, et al. Use of the emergency department for severe headache (A population-based study). Headache. 2009;49:21–30
  25. Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med. 2006;48:9–16
  26. Griswold SK, Nordstrom CR, Clark S, et al. Asthma exacerbations in North American adults: who are the “frequent fliers” in the emergency department?. Chest. 2005;127:1579–1586
  27. Hunt KA, Weber EJ, Showstack JA, et al. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48:1–8
  28. Kne T, Young R, Spillane L. Frequent ED users: patterns of use over time. Am J Emerg Med. 1998;16:648–652
  29. Pines JM, Buford K. Predictors of frequent emergency department utilization in southeastern Pennsylvania. J Asthma. 2006;43:219–223
  30. Sun BC, Burstin HR, Brennan TA. Predictors and outcomes of frequent emergency department users. Acad Emerg Med. 2003;10:320–328
  31. Xu KT, Nelson BK, Berk S. The changing profile of patients who used emergency department services in the United States: 1996 to 2005. Ann Emerg Med. 2009;54:805–810e1-7
  32. Zuckerman S, Shen YC. Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter?. Med Care. 2004;42:176–182
  33. Chan BT, Ovens HJ. Frequent users of emergency departments (Do they also use family physicians' services?). Can Fam Physician. 2002;48:1654–1660
  34. Grafstein E, Burton K, Innes G. Evaluation of a program to address frequent emergency department users. Acad Emerg Med. 2004;11:455–456
  35. Hansagi H, Edhag O, Allebeck P. High consumers of health care in emergency units: how to improve their quality of care. Qual Assur Health Care. 1991;3:51–62
  36. Hansagi H, Olsson M, Hussain A, et al. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users?. Eur J Emerg Med. 2008;15:34–39
  37. Hansagi H, Olsson M, Sjoberg S, et al. Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med. 2001;37:561–567
  38. Helliwell PE, Hider PN, Ardagh MW. Frequent attenders at Christchurch Hospital's emergency department. N Z Med J. 2001;114:160–161
  39. Huang JA, Lai CS, Tsai WC, et al. Determining factors of patient satisfaction for frequent users of emergency services in a medical center. J Chin Med Assoc. 2004;67:403–410
  40. Huang JA, Tsai WC, Chen YC, et al. Factors associated with frequent use of emergency services in a medical center. J Formos Med Assoc. 2003;102:222–228
  41. Huang JA, Weng RH, Lai CS, et al. Exploring medical utilization patterns of emergency department users. J Formos Med Assoc. 2008;107:119–128
  42. Kennedy D, Ardagh M. Frequent attenders at Christchurch Hospital's Emergency Department: a 4-year study of attendance patterns. N Z Med J. 2004;117:U871
  43. Lang T, Davido A, Diakite B, et al. Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect?. J Epidemiol Community Health. 1996;50:456–462
  44. Murphy AW, Leonard C, Plunkett PK, et al. Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period. J Accid Emerg Med. 1999;16:425–427
  45. Olsson M, Hansagi H. Repeated use of the emergency department: qualitative study of the patient's perspective. Emerg Med J. 2001;18:430–434
  46. Ovens HJ, Chan BT. Heavy users of emergency services: a population-based review. CMAJ. 2001;165:1049–1050
  47. Williams JM, Furbee PM, Hungerford DW, et al. Injury recidivism in a rural ED. Ann Emerg Med. 1997;30:176–180
  48. Williams RM. Frequent emergency department use in Sweden: implications for emergency medicine in the United States. Ann Emerg Med. 2001;37:627–629
  49. Genell Andren K, Rosenqvist U. Heavy users of an emergency department—a two year follow-up study. Soc Sci Med. 1987;25:825–831
  50. Pope D, Fernandes CM, Bouthillette F, et al. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162:1017–1020
  51. Baker DW, Stevens CD, Brook RH. Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. JAMA. 1994;271:1909–1912
  52. Hayward RA, Bernard AM, Freeman HE, et al. Regular source of ambulatory care and access to health services. Am J Public Health. 1991;81:434–438
  53. Malone RE. Heavy users of emergency services: social construction of a policy problem. Soc Sci Med. 1995;40:469–477
  54. McCusker J, Healey E, Bellavance F, et al. Predictors of repeat emergency department visits by elders. Acad Emerg Med. 1997;4:581–588
  55. O'Brien GM, Stein MD, Zierler S, et al. Use of the ED as a regular source of care: associated factors beyond lack of health insurance. Ann Emerg Med. 1997;30:286–291
  56. Purdie FR, Honigman B, Rosen P. The chronic emergency department patient. Ann Emerg Med. 1981;10:298–301
  57. Sadowski LS, Kee RA, VanderWeele TJ, et al. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009;301:1771–1778
  58. Shumway M, Boccellari A, O'Brien K, et al. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. Am J Emerg Med. 2008;26:155–164
  59. Spillane LL, Lumb EW, Cobaugh DJ, et al. Frequent users of the emergency department: can we intervene?. Acad Emerg Med. 1997;4:574–580
  60. Ciaranello AL, Molitor F, Leamon M, et al. Providing health care services to the formerly homeless: a quasi-experimental evaluation. J Health Care Poor Underserved. 2006;17:441–461
  61. Lee KH, Davenport L. Can case management interventions reduce the number of emergency department visits by frequent users?. Health Care Manag (Frederick). 2006;25:155–159
  62. Okin RL, Boccellari A, Azocar F, et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18:603–608
  63. Higgins JC, Kiser WR, McClenathan S, et al. Influence of an interventional program on resource use and cost in pediatric asthma. Am J Manag Care. 1998;4:1465–1469
  64. O'Shea JS, Collins EW, Pezzullo JC. An attempt to influence health care visits of frequent hospital emergency facility users. Clin Pediatr. 1984;23:559–562
  65. Kelly CS, Morrow AL, Shults J, et al. Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in Medicaid. Pediatrics. 2000;105:1029–1035
  66. Kravitz RL, Zwanziger J, Hosek S, et al. Effect of a large managed care program on emergency department use: results from the CHAMPUS reform initiative evaluation. Ann Emerg Med. 1998;31:741–748
  67. Handel DA, McConnell KJ, Wallace N, et al. How much does emergency department use affect the cost of Medicaid programs?. Ann Emerg Med. 2008;51:614–621e611

 Supervising editor: Donald M. Yealy, MD

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online March 26, 2010.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Reprints not available from the authors.

PII: S0196-0644(10)00105-8

doi: 10.1016/j.annemergmed.2010.01.032

Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 42-48 , July 2010

Article Tools