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Frequent attendances at emergency departments in England
  1. Geva Greenfield1,
  2. Mitch Blair1,
  3. Paul P Aylin1,
  4. Sonia Saxena1,
  5. Azeem Majeed1,
  6. Maurice Hoffman2,
  7. Alex Bottle1
  1. 1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  2. 2Collaboration for Leadership in Applied Health Research and Care Northwest London, London, UK
  1. Correspondence to Dr Geva Greenfield, Department of Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London SW7 2BU, UK; g.greenfield{at}ic.ac.uk

Abstract

Background A small proportion of patients referred to as ‘frequent attenders’ account for a large proportion of hospital activity such as ED attendances and admissions. There is a lack of recent, national estimates of the volume of frequent ED attenders. We aimed to estimate the volume and age distribution of frequent ED attenders in English hospitals.

Method We included all attendances at all major EDs across England in the financial year 2016–2017. Patients who attended three times or more were classified as frequent attenders. We used a logistic regression model to predict the odds of being a frequent attender by age group.

Results 14 829 519 attendances were made by 10 062 847 patients who attended at least once. 73.5% of ED attenders attended once and accounted for 49.8% of the total ED attendances. 9.5% of ED attenders attended three times or more; they accounted for 27.1% of the ED attendances. While only 1.2% attended six times or more, their contribution was 7.6% of the total attendances. Infants and adults aged over 80 years were significantly more likely to be frequent attenders than adults aged 30–59 years (OR=2.11, 95% CI 2.09 to 2.13, OR=2.22, 95% CI 2.20 to 2.23, respectively). The likelihood of hospital admission rose steeply with the number of attendances a patient had.

Conclusion One in 10 patients attending the ED are frequent attenders and account for over a quarter of attendances. Emergency care systems should consider better ways of reorganising health services to meet the needs of patients who attend EDs frequently.

  • emergency department utilisation
  • emergency care systems
  • emergency care systems, emergency departments
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Footnotes

  • Contributors GG was involved with conception and design, conducted the data analysis and drafted the manuscript. MB was involved with acquisition of funding, conception and design, data analysis and revised various versions of the manuscript. PA was involved with acquisition of funding, conception and design, data collection and analysis, and revised various versions of the manuscript. SS was involved with acquisition of funding, conception and design, data analysis and revised various versions of the manuscript. AM was involved with acquisition of funding, conception and design, data analysis and revised various versions of the manuscript. MH was involved with data analysis and revised various versions of the manuscript. AB was involved with acquisition of funding, conception and design, data collection and analysis, and revised various versions of the manuscript. All authors read and approved the final manuscript.

  • Competing interests SS is funded by the NIHR School for Public Health Research and NW London ARC. In addition, she holds funding from The Daily Mile Foundation unrelated to this research.

  • Patient consent for publication Not required.

  • Ethics approval We have approval from the Secretary of State and the Health Research Authority under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 to hold confidential data and analyse them for research purposes (CAG ref 15/CAG/0005). We have approval to use them for research and measuring quality of delivery of healthcare, from the London - South East Ethics Committee (REC ref 15/LO/0824).

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

  • Data availability statement We are not allowed to share any data.

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