title: Characterising emergency department high-frequency users in a rural hospital.
abstract: OBJECTIVE
  Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses.
  
  
  METHODS
  Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses.
  
  
  RESULTS
  Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users.
  
  
  CONCLUSIONS
  These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.
authors.affiliation: College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Hardie
authors.affiliation: School of Nursing, University of Delaware, Newark, Delaware, USA.
authors.forename: Carolee
authors.initials: C
authors.lastname: Polek
authors.affiliation: School of Nursing, University of Delaware, Newark, Delaware, USA.
authors.forename: Erlinda
authors.initials: E
authors.lastname: Wheeler
authors.affiliation: American Nurses Credentialing Center, Silver Springs, Maryland, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: McCamant
authors.affiliation: Emergency Services, Union Hospital of Cecil County, Elkton, Maryland, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Dixson
authors.affiliation: Union Hospital of Cecil County Maryland, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gailey
authors.affiliation: Department of Emergency Medicine, Union Hospital of Cecil County, Elkton, Maryland, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Lafrak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D012189:Retrospective Studies
keywords: emergency care systems; epidemiology; primary care; remote and rural medicine; research