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Heterogeneity of reasons for attendance in frequent attenders of emergency departments and its relationship to future attendance
  1. Richard Hotham1,
  2. Colin O'Keeffe2,
  3. Tony Stone2,
  4. Suzanne M Mason2,
  5. Christopher Burton1
  1. 1 Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
  2. 2 School of Health and Related Research, The University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Christopher Burton, Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield S5 7AU, UK; chris.burton{at}


Background EDs globally are under increasing pressure through rising demand. Frequent attenders are known to have complex health needs and use a disproportionate amount of resources. We hypothesised that heterogeneity of patients’ reason for attendance would be associated with multimorbidity and increasing age, and predict future attendance.

Method We analysed an anonymised dataset of all ED visits over the course of 2014 in Yorkshire, UK. We identified 15 986 patients who had five or more ED encounters at any ED in the calendar year. Presenting complaint was categorised into one of 14 categories based on the Emergency Care Data Set (ECDS). We calculated measures of heterogeneity (count of ECDs categories and entropy of categories) and examined their relationship to total number of ED visits and to patient characteristics. We examined the predictive value of these and other features on future attendance.

Results Most frequent attenders had more than one presenting complaint type. Heterogeneity increased with number of attendances, but heterogeneity adjusted for number of attendances did not vary substantially with age or sex. Heterogeneity was associated with the presence of one or more contacts for a mental health problem. For a given number of attendances, prior mental health contact but not heterogeneity was associated with further attendance.

Conclusions Heterogeneity of presenting complaint can be quantified and analysed for ED use: it is increased where there is a history of mental disorder but not with age. This suggests it reflects more than the number of medical conditions.

  • crowding
  • emergency care systems
  • emergency departments

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  • Handling editor Kirsty Challen

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  • Contributors CB had the original idea for the study and all authors were involved in design. TS, SMM and CO’K provided the data and RH and CB carried out the analysis. RH wrote the first draft of the paper which was edited and reviewed by all authors.

  • Funding The study used data collected as part of the NIHR Collaboration for Leadership in Applied Research and Care (CLAHRC) Yorkshire and Humber (Y&H). SMM, CO’K and TS are funded by the National Institute for Health Research Yorkshire and Humber ARC.

  • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.