title: The impact of frequent attenders on a UK emergency department.
abstract: BACKGROUND
  Previous studies have identified that there is a cohort of frequent attenders to the emergency department (ED). Recent initiatives aim to provide care closer to home and alternatives to ED attendance. This study aims to identify what impact frequent attenders still have on the ED.
  
  
  METHODS
  A chart review of frequent attenders to the ED was carried out over a 12-month period. Inclusion criterion was 10 or more attendances. Information collected comprised age, sex, postcode, next of kin, number of attendances, day of the week, time, referral source, mode of arrival, triage category, disposal, association with alcohol and drug use, presenting complaint, and diagnosis.
  
  
  RESULTS
  Forty-four frequent users met the study criterion accounting for 1.9% of departmental activity. Sixty-four percent of frequent attenders were male with an average age of 49 years (range 19-83). The majority lived within 5 miles of the ED. Sixty percent of attendances arrived at the ED through ambulance. Documentation of either concurrent alcohol use or history of alcohol dependence and illicit drug use was reported in 54.6 and 15.9% of patients. The admission rate of this group was 38.5% higher than the total ED admission rate of 22%.
  
  
  CONCLUSIONS
  There remains a cohort of frequent attenders that use the ED for their healthcare needs. A significant proportion of these attendances are associated with alcohol use, chronic disease or mental health problems. Reduction of attendances may be achieved by case management strategies and improving access to primary care and drug and alcohol services.
authors.affiliation: School of Medical Education, University of Liverpool, Cedar House, Liverpool, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Dent
authors.forename: Glenys
authors.initials: G
authors.lastname: Hunter
authors.forename: Andrew Philip
authors.initials: AP
authors.lastname: Webster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019966:Substance-Related Disorders / Q000150:complications; D013997:Time Factors; D014218:Triage / Q000706:statistics & numerical data; D006113:United Kingdom; D055815:Young Adult