title: Patients who use multiple EDs: quantifying the degree of overlap between ED populations.
abstract: BACKGROUND
  The degree to which individual patients use multiple emergency departments (EDs) is not well-characterized. We determined the degree of overlap in ED population between three geographically proximate hospitals.
  
  
  METHODS
  This retrospective cohort study reviewed administrative hospital records from 2003 to 2007 for patients registered to receive ED services at an urban academic, urban community, and suburban community ED located within 10 miles of one another. We determined the proportion who sought care at multiple EDs and secondarily characterized patterns of repeat encounters.
  
  
  RESULTS
  There were 795,176 encounters involving 282,903 patients. There were 89,776 (31%) patients with multiple encounters to a single ED and 39,920 (14%) patients who sought care from multiple EDs. The 39,920 patients who sought care from multiple EDs generated 185,629 (23%) of all encounters. Patients with repeat encounters involving multiple EDs were more likely to be frequent or highly frequent users (30%) than patients with multiple encounters to a single ED (14%).
  
  
  CONCLUSIONS
  While only 14% of patients received care from more than one ED, they were responsible for a quarter of ED encounters. Patients who use multiple EDs are more often frequent or highly frequent users than are repeat ED visitors to the same ED. Overlap between ED populations is sufficient to warrant consideration by multiple domains of research, practice, and policy.
authors.affiliation: Emergency Services Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Baruch S
authors.initials: BS
authors.lastname: Fertel
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio ; University of Cincinnati, Center for Clinical and Translational Science and Training, Cincinnati, Ohio.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ryan
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
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