The heaviest repeat users of an inner city emergency department are not general practice patients

Abstract

Objective: To test the hypothesis that frequent attenders to the ED are suitable for diversion to general practice.

Methods: A retrospective review of a computerized database for the top 500 frequent presenters to an inner city adult teaching hospital ED.

Results: Five hundred patients presented 12,940 times, an average of 26 times per patient, accounting for (8.4% [8.3, 8.6]) of total ED presentations over 64 months. There were 7699 (59.5% [58.7, 60.4]) presentations deemed appropriate for ED. Of the remaining 5241 presentations, 1553 (29.6% [28.4, 30.9]) were between 22.00 and 07.00 hours, outside the hours of most actual or proposed primary care clinics. This left 3688 (28.5% [27.7, 29.3]) presentations by the heaviest users of the ED as potentially appropriate for general practice. Of these presentations 1507 (40.9% [39.3, 42.5]) were by people who were homeless. A total of 2574 (69.8% [68.3, 71.3]) had pre-existing case management, either by the hospital or another service. Nine hundred and seventy-eight (26.5% [25.1, 28.0]) had primary psychiatric or altered conscious states due to drugs and alcohol as the presenting problem. At least 90 of these 500 frequently presenting patients died during the study period.

Conclusion: The majority of the presentations by the heaviest users of an ED in a city teaching hospital are not suitable for general practice. Attempting diversion of the heaviest repeat ED users to a general practice in this setting may not be successful due to the severity, acuity and nature of casemix of the presentations and would have minimal impact on crowding in similar emergency departments.