Many different definitions for “ED recurrence” have been reported but most articles consistently defined at least four ED visits during a one-year period as a recurrent ED visitor. While EDs were primary designed for “real” emergency care, recurrent visitors to the ED due to various medical problems constitute a considerable proportion of the total number of ED visits. These recurrent ED visits also charge costs, insurance companies and the healthcare system significantly more compared with patients adequately managed by primary care providers.
The subgroup of patients who repeatedly use the ED is still a small proportion of ED patients but extensively use ED resources, causing ED overcrowding and decreasing the quality and efficiency of emergency care. In addition, this rise of visits results in ED overcrowding. Healthcare costs are also burdened by the continuous rise of visits to emergency departments (ED). It significantly burdens the gross domestic product and needs to be reduced. Swiss healthcare costs continued to rise to a total of 80.7 billion CHF in 2016, which was 3.8% more compared to 2015. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled ( p = 0.001), had an increased Charlson co-morbidity index ( p = 0.004) or suffering from rheumatic diseases ( p < 0.001). Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases ( p < 0.001) and mental disorders ( p < 0.001). Repeated ED users had more ED visits ( p < 0.001) and needed more hospital admissions ( p < 0.010) compared to frequent ED users. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits.
Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding.
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