2.50
Hdl Handle:
http://hdl.handle.net/10755/162474
Type:
Presentation
Title:
Frequent Users of Emergency Department Services
Abstract:
Frequent Users of Emergency Department Services
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Halm, Margo, RN, PhD, APRN-BC, CCRN
P.I. Institution Name:United Hospital
Title:Director of Nursing Research & Quality
Contact Address:333 N. Smith Avenue, St. Paul, MN, 55102, USA
Contact Telephone:(651) 241-8536
Co-Authors:Pat Milbrett, RN
[Research Presentation] Purpose: Public use of emergency department (ED) services continues to increase. While frequent users account for only a small percentage of visits, these patients put a drain on the system that may contribute to overcrowding and lowered quality of care. This study aimed to describe the characteristics of patients who frequently use ED services, and to determine which factors are most predictive of high ED utilization.

Design: A retrospective descriptive correlational design was used to answer the research questions:
1. What are the characteristics of patients who visited the emergency department at least six times in 2005?
2. Is there a significant difference in the number of ED visits between the top five chief complaints?
3. What factors are most predictive of frequent ED visits?

Setting: A Midwestern urban emergency department with greater than 40,000 annual visits.

Sample: Adult patients visiting the emergency department at least six times in 2005 (N=201). Of these, six visits were randomly chosen (N=1,200 of 2,056 possible visits=5% all visits).

Methodology: A tool, based on a literature review of factors associated with frequent ED use, was developed to abstract chart information on each randomly chosen visit. This tool included demographic, social, and clinical factors such as health history, chief complaints, disposition and total visits.

Results: Based on descriptive statistics, patients were predominantly female, 35 years old, Caucasian, single, unemployed but with insurance and a primary physician. Over half had a history of a chronic condition, and over one-third had a psychiatric diagnosis. The number of ED visits ranged from 6-52 (but 69% <10 visits) and almost all were discharged home. Top chief complaints across visits were abdominal/flank pain, low back pain, headache/migraine, chest pain, and lower extremity pain. No significance difference was found in the number of ED visits among these top chief complaints. Using chi-square or Mann-Whitney U tests, several differences were found between chief complaints across visits by gender and age groups, as well as by shift of the visit. Using a Poisson regression, factors predictive of high ED utilization (p<.05) were: Male, non-black race, employed part-time, retired/unemployed, Medicare, and complaint of upper respiratory infection. Headache was approaching significance (p=.06).

Conclusions: Frequent ED users have health needs that are often not solved by ED visits. Other interventions such as multidisciplinary care plans involving primary physicians or comprehensive case management are needed to fill care gaps and preserve ED services for those with the most critical health care needs.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFrequent Users of Emergency Department Servicesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162474-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Frequent Users of Emergency Department Services</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Halm, Margo, RN, PhD, APRN-BC, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">United Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Nursing Research &amp; Quality</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">333 N. Smith Avenue, St. Paul, MN, 55102, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(651) 241-8536</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">margo.a.halm@allina.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Pat Milbrett, RN</td></tr><tr><td colspan="2" class="item-abstract">[Research Presentation] Purpose: Public use of emergency department (ED) services continues to increase. While frequent users account for only a small percentage of visits, these patients put a drain on the system that may contribute to overcrowding and lowered quality of care. This study aimed to describe the characteristics of patients who frequently use ED services, and to determine which factors are most predictive of high ED utilization. <br/><br/>Design: A retrospective descriptive correlational design was used to answer the research questions:<br/>1. What are the characteristics of patients who visited the emergency department at least six times in 2005?<br/>2. Is there a significant difference in the number of ED visits between the top five chief complaints?<br/>3. What factors are most predictive of frequent ED visits?<br/><br/>Setting: A Midwestern urban emergency department with greater than 40,000 annual visits.<br/><br/>Sample: Adult patients visiting the emergency department at least six times in 2005 (N=201). Of these, six visits were randomly chosen (N=1,200 of 2,056 possible visits=5% all visits).<br/><br/>Methodology: A tool, based on a literature review of factors associated with frequent ED use, was developed to abstract chart information on each randomly chosen visit. This tool included demographic, social, and clinical factors such as health history, chief complaints, disposition and total visits. <br/><br/>Results: Based on descriptive statistics, patients were predominantly female, 35 years old, Caucasian, single, unemployed but with insurance and a primary physician. Over half had a history of a chronic condition, and over one-third had a psychiatric diagnosis. The number of ED visits ranged from 6-52 (but 69% &lt;10 visits) and almost all were discharged home. Top chief complaints across visits were abdominal/flank pain, low back pain, headache/migraine, chest pain, and lower extremity pain. No significance difference was found in the number of ED visits among these top chief complaints. Using chi-square or Mann-Whitney U tests, several differences were found between chief complaints across visits by gender and age groups, as well as by shift of the visit. Using a Poisson regression, factors predictive of high ED utilization (p&lt;.05) were: Male, non-black race, employed part-time, retired/unemployed, Medicare, and complaint of upper respiratory infection. Headache was approaching significance (p=.06).<br/><br/>Conclusions: Frequent ED users have health needs that are often not solved by ED visits. Other interventions such as multidisciplinary care plans involving primary physicians or comprehensive case management are needed to fill care gaps and preserve ED services for those with the most critical health care needs.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:49Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:49Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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