Background: There is a significant literature examining the reasons why patients attend emergency departments frequently. This body of work suggests that sociodemographic characteristics are important in understanding why patients re-attend, but it does not provide a definition of what frequent attendance means. This paper aims to identify personal and attendance factors associated with frequent attendance at an emergency department.
Methods: One-year emergency department attendance data from a south-east London teaching hospital (2006–7) were analysed. The dataset was analysed at two levels: the individual patient level and the attendance level. Frequencies and cross-tabulations were produced to describe the dataset. Confidence intervals were calculated for both patient and attendance level data.
Results: 82 812 patients made 117 187 attendances to the emergency department during 1 year. Each patient made an average of 1.4 attendances; 46% were repeat attendances. The analysis demonstrated differences in the personal and attendance profile of patients who attended the emergency department more frequently during the study period. A change in the patient profile first appeared at the fourth attendance and the change became more pronounced as attendances increased. Frequent attenders were more likely to be men (50.5% of single attendances; 69.5% of ⩾10 attendances), older (single attendance, mean age 32 years; ⩾10 attendances, mean age 45.6 years), to attend outside daytime hours (51.4% of single attendances; 69.2% of ⩾10 attendances) and to be triaged into the more serious categories (36.1% of single attendances; 54.3% of ⩾10 attendances).
Conclusion: Where local services are being designed to divert frequent attenders, existing data sources can be a rich source of information to inform service design. For example, this analysis identifies older men at their fourth or more attendance as a potentially important group when examining frequent attendance at this particular hospital. It also identified a potential need for services outside normal surgery hours, although frequent attenders tend to be triaged into the more urgent categories.
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Funding: LM undertook this work as a research fellow seconded to the Department of General Practice and Primary Care at King’s College London. This research fellowship was funded by Guy’s and St Thomas’ Charity through the Primary and Community Care Research Support Programme.
Competing interests: None.
Ethics approval: The Chair of the local research ethics committee considered this work to be an audit of patients and as a result the project did not need to be formally submitted to the Research Committee.
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