title: A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users.
abstract: BACKGROUND
  Emergency department (ED) overcrowding has been a significant problem for the last 10 years. Several studies have shown that a relatively small number of ED patients are responsible for a disproportionate amount of ED visits. This study aims to describe the frequent users of our emergency department.
  
  
  METHODS
  This was an institutional review board-approved descriptive study performed by a retrospective review of electronic records. This pilot describes and compares patients who had 12 or more ED visits during the study year with those who visited less.
  
  
  RESULTS
  The 234 patients who met criteria for high-frequency use (HFU) of the emergency department were responsible for a total of 4633 visits. Sex, race, and age distribution of HFU patients were similar to those of general ED patients. Eighty-four percent of HF users have insurance and 93% have primary care providers. A relatively small percentage of HFU visits, 4%, were mental health-related visits and 3% were alcohol- and drug-related visits. The HFU visits are socially connected: 93% have their own homes; 94% have relatives or friends; 73% have a religious affiliation. Pain or pain-related conditions are the most common diagnoses. These patients are also frequent users of ambulatory care services.
  
  
  CONCLUSIONS
  The similarities between our HFU and the general ED population are more numerous than their differences. The HFU patients of our emergency department are different in terms of age, employment status, and type of insurance. IMPLICATIONS FOR NURSES: A detailed description of local HFU may help to inform planning and better meet ED patients' needs. As one of many results of this study, the ED chairman met with the Hematology-Oncology team and reviewed the protocol for ED management of sickle cell crisis. The meeting resulted in a revised protocol, including an immediate change in their pain medication from meperidine to either morphine or hydromorphone.
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA. Del.Blank@bhs.org
authors.forename: Fidela S J
authors.initials: FS
authors.lastname: Blank
authors.forename: Haiping
authors.initials: H
authors.lastname: Li
authors.forename: Philip L
authors.initials: PL
authors.lastname: Henneman
authors.forename: Howard A
authors.initials: HA
authors.lastname: Smithline
authors.forename: John S
authors.initials: JS
authors.lastname: Santoro
authors.forename: Deborah
authors.initials: D
authors.lastname: Provost
authors.forename: Ann M
authors.initials: AM
authors.lastname: Maynard
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000755:Anemia, Sickle Cell / Q000453:epidemiology / Q000628:therapy; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010865:Pilot Projects; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D012944:Social Support