Aims, Objectives and Background The Royal College of Emergency Medicine defines Frequent Attenders (FA) as anyone who attends the Emergency Department(ED) five or more times per year. This group has a high mortality and is a significant burden on services. The Bristol Royal infirmary (BRI) is a city-centre adult-only ED, where 1.8% of our patients are FAs, with a 5 year mortality rate of 20% in this group. Our aim was to further develop a triage tool used by the BRI High Impact User team, by determining which factors increase mortality in our population.
Method and Design Data was collected retrospectively from 250 electronic patient records, randomly selected from 1780 FAs attending in 2016. Six variables were chosen for analysis: current mental health problems(MHP), homelessness, injecting drug use, alcohol misuse, chronic medical problems(CMP) and number of attendances that year. Data on age, gender and 5-year mortality were also recorded. Logistic regression modeling was performed to determine which factors best predicted 5-year mortality.
Results and Conclusion Univariate analysis, found that age and CMPs were the only two variables independently associated with 5-year mortality.
FAs attending 10–20 times per year with MHP(n=22) had a higher mortality (31.3%) than those in the >20 attendances group (n=6) where 5-year mortality was 0%. Multivariate analysis suggested different predictors of mortality depending on the presence or absence of MHP. Therefore two different algorithms were derived; both of which had AUROC of over 0.7.
This was a small-scale service development using a specific cohort of FAs. Our findings are not generalisable. However they highlight a complex relationship between risk factors, attendance frequency and mortality. We must question whether efforts to reduce ED attendances for FAs risks inadvertently discouraging high risk patients from accessing potentially protective interactions. We hope to encourage other EDs to develop similar tools for their FA populations.
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