ED Frequent Flyer Points

A large six and a half year population study has just been published in the MJA. Frequent attenders at emergency departments: a linked-data population study of adult patients. The study looked at all the adults attending the nine emergency departments in Perth, Western Australia with a view to better understanding the type of patients who frequently attend ED’s (> 5 times annually) – the frequent flyers (FF)

Surprisingly the annual percentage of frequent flyer attendances was small (2.4%). More surprisingly, apart from a tiny percentage of extremely frequent attenders, almost all of these patients were more urgent, sicker, came by ambulance more often and were more often admitted. They really needed to be in hospital!

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 group of patients attending between 5–19 times per year (97.4% of FFs) had more urgent conditions, more circulatory system disease and higher admission rates than all other patients. The more frequently patients attended the more likely they were to be male, middle-aged and late-middle-aged, self-referred, have mental and behavioural disorders and alcohol intoxication, to not wait to be assessed, and to arrive by ambulance.

This is in contrast to the popular myths about so-called ED ‘frequent flyers’, that is that they are illegitimate users of ED services or should be seen in general practice.

Conclusion:

Most frequent attenders 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.

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