Characteristics of frequent attenders in an emergency department: analysis of 1-year attendance data.
BACKGROUND
There is a significant literature examining the reasons why patients attend emergency departments frequently. This body of work suggests that sociodemographic characteristics are important in understanding why patients re-attend, but it does not provide a definition of what frequent attendance means. This paper aims to identify personal and attendance factors associated with frequent attendance at an emergency department.


METHODS
One-year emergency department attendance data from a south-east London teaching hospital (2006-7) were analysed. The dataset was analysed at two levels: the individual patient level and the attendance level. Frequencies and cross-tabulations were produced to describe the dataset. Confidence intervals were calculated for both patient and attendance level data.


RESULTS
82 812 patients made 117 187 attendances to the emergency department during 1 year. Each patient made an average of 1.4 attendances; 46% were repeat attendances. The analysis demonstrated differences in the personal and attendance profile of patients who attended the emergency department more frequently during the study period. A change in the patient profile first appeared at the fourth attendance and the change became more pronounced as attendances increased. Frequent attenders were more likely to be men (50.5% of single attendances; 69.5% of > or =10 attendances), older (single attendance, mean age 32 years; > or =10 attendances, mean age 45.6 years), to attend outside daytime hours (51.4% of single attendances; 69.2% of > or =10 attendances) and to be triaged into the more serious categories (36.1% of single attendances; 54.3% of > or =10 attendances).


CONCLUSIONS
Where local services are being designed to divert frequent attenders, existing data sources can be a rich source of information to inform service design. For example, this analysis identifies older men at their fourth or more attendance as a potentially important group when examining frequent attendance at this particular hospital. It also identified a potential need for services outside normal surgery hours, although frequent attenders tend to be triaged into the more urgent categories.
Moore
L
L
Department of General Practice and Primary Care, King's College London, UK. lynda.moore@southwarkpct.nhs.uk
Deehan
A
A
Seed
P
P
Jones
R
R
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research / Q000379:methods; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010507:Periodicity; D012737:Sex Factors; D014218:Triage / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult