High mortality rates from medical problems of frequent emergency department users at a university hospital tertiary care centre

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Abstract
Frequent emergency department (ED) users are a nebulous group of patients. A high degree of psychiatric problems and higher than expected mortality from medical illness have been reported in this population. We sought to examine the pattern of ED use by adult patients identified as being heavy users of the ED, to examine their demographic characteristics and describe their clinical profile during a one-year period at one institution. This was a descriptive, retrospective study that took place in the ED of a 1000-bed teaching hospital in Barcelona, Spain, with a population in the metropolitan area of 1.5 million, which attends approximately 110,000 emergency visits per year, excluding paediatrics and obstetrics. The ED computer registration database was used to identify all patients presenting to the hospital ED more than 10 times in a one-year period from 1 January to 31 December 2000. A cohort composed of 86 patients fitting these inclusion criteria was identified as making 1263 (1.1%) of the total 109,857 ED visits. All medical records for each patient were reviewed to determine the primary reason for repeated ED visits. Of the 86 patients enrolled, 58 were men (67.4%). The mean age was 55 years (range 18-91), but only six patients (6.9%) were older than 80 years. The median number of ED visits per patient was 14 throughout the year. Forty-five of the patients (52.3%) were classified as having primarily medical reasons for presenting to the ED, with diagnoses such as shortness of breath and chest pain being the chief symptoms. Seventeen patients (19.7%) had a surgical problem as the cause of their ED visits, and eight (9.3%) had psychiatric problems contributing to the ED visits. Other major reasons for presentation to the ED were as follows: ophthalmic, eight patients (9.3%); otolaryngological, four patients (4.6%); and trauma, four patients (4.6%). A total of 982 (77.8%) of the total ED visits resulted in home discharge. Hospital emergency admissions and outpatient clinics diversions occurred in 106 (8.3%) and 71 (5.6%) ED visits, respectively. The mortality rate was as high as 18.6% (16 frequent ED users died). These data show that there is a high incidence of medical problems in frequent ED users and a high incidence of mortality in patients with heavy ED use.

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