Journal Article

An observational pilot study: Prevalence and cost of high frequency emergency department users at Örebro University Hospital, Sweden

Lundqvist, Christer, Andersson, Jonas, Kurland, Lisa, Cheng, Ivy

2022

Overview

There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU. This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018-19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was [greater than or equal to]4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4-7, 8-18 and [greater than or equal to]19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU. Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen. ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acuity / Confidence intervals / Cost analysis / Costs / Electronic health records / Emergency medical care / Emergency medical services / Emergency service / Engineering and Technology / Ethnicity / Evaluation / Family physicians / Health care expenditures / Health care policy / High frequencies / Hospitals / Jurisdiction / Medical care, Cost of / Medicine and Health Sciences / Observational studies / Pain / Patients / Pediatrics / People and places / Systematic review