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Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review
  1. Jessica Moe1,
  2. Scott Kirkland2,
  3. Maria B Ospina3,
  4. Sandy Campbell4,
  5. Rebecca Long2,
  6. Alan Davidson2,
  7. Patrick Duke2,
  8. Tomo Tamura2,
  9. Lisa Trahan5,
  10. Brian H Rowe5
  1. 1RCPS Emergency Medicine Residency Program, Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Emergency Medicine Research Group, University of Alberta, Edmonton, Alberta, Canada
  3. 3Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
  4. 4J. W. Scott Health Sciences Library, 2K4.01 WC Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
  5. 5Department of Emergency Medicine, University of Alberta Hospital, 1G1.42 Walter C. Mackenzie Centre, Edmonton, Alberta, Canada
  1. Correspondence to Dr Brian H Rowe, Department of Emergency Medicine, University of Alberta Hospital, 1G1.42 Walter C. Mackenzie Centre, 8440-112 Street NW, Edmonton, Alberta, Canada T6G 2B7; brian.rowe{at}ualberta.ca

Abstract

Objective This systematic review examines whether frequent emergency department (ED) users experience higher mortality, hospital admissions and outpatient visits than non-frequent ED users.

Design We published an a priori study protocol in PROSPERO. Our search strategy combined terms for ‘frequent users’ and ‘emergency department’. At least two independent reviewers screened, selected, assessed quality and extracted data. Third-party adjudication resolved conflicts. Results were synthesised based on median effect sizes.

Data sources We searched seven electronic databases with no limits and performed an extensive grey literature search.

Eligibility criteria for selecting studies We included observational analytical studies that focused on adult patients, had a comparison group of non-frequent ED users and reported deaths, admissions and/or outpatient outcomes.

Results The search strategy identified 4004 citations; 374 were screened by full text and 31 cohort and cross-sectional studies were included. Authors used many different definitions to describe frequent users; the overall quality of the included studies was moderate. Across seven studies examining mortality, frequent users had a median 2.2-fold increased odds of mortality compared with non-frequent users. Twenty-eight studies assessing hospital admissions found a median increased odds of admissions per visit at 1.16 and of admissions per patient at 2.58. Ten studies reported outpatient visits with a median 2.65-fold increased risk of having at least one outpatient encounter post-ED visit.

Conclusions Frequent ED users appear to experience higher mortality, hospital admissions and outpatient visits compared with non-frequent users, and may benefit from targeted interventions. Standardised definitions to facilitate comparable research are urgently needed.

Review registration number: PROSPERO (CRD42013005855).

  • emergency department
  • management, cost efficiency
  • management, emergency department management
  • emergency care systems, efficiency
  • emergency care systems, emergency departments

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