Frequent attenders at emergency departments: a linked-data population study of adult patients

Objectives: To examine the characteristics of adult patient attendances to emergency departments (EDs) in Perth hospitals by patients’ frequency of attendance.Design, setting and participants: A linked-data population study of adults (aged ≥ 15 years) attending all nine Perth hospital EDs between 1 July 2000 and 31 December 2006.Main outcome measures: Proportion of frequent attenders (FAs; those attending five or more times annually); and demographic characteristics, mode of arrival at the ED, disposition (admission, transfer, discharge or death), urgency and clinical conditions by frequency of attendance.Results: There was a mean of 1.5 attendances per individual per year, resulting in 1 583 924 attendances by 663 309 individuals over the 6.5 years of the study. Most patients (97.6%) attended Perth EDs fewer than five times a year. The more frequently patients attended, the more likely they were to be male, middle-aged and late-middle-aged, have self-referred, have mental and behavioural disorders and alcohol intoxication, to not wait to be assessed, and to arrive by ambulance. The groups of patients attending between 5–9 and 10–19 times per year (97.4% of FAs) had more urgent conditions, more circulatory system disease and higher admission rates than all other patients.Conclusion: Most FAs at Perth EDs present fewer than 20 times a year and have more serious and urgent illness than other patients, more often requiring inpatient services. A very small minority of patients (around 100 patients/year) attends 20 or more times a year, many with mental and behavioural disorders and alcohol intoxication not requiring hospital admission.