Characteristics of frequent attenders in an emergency department: analysis of 1-year attendance data
Characteristics of frequent attenders in an emergency department: analysis of 1-year attendance data
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DOI：
10.1136/emj.2008.059428
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发表时间：
2009-04-01
影响因子：
3.1
通讯作者：
Jones, R.
中科院分区：
文献类型：
--
作者：
Moore, L.;Deehan, A.;Jones, R.
背景：有一篇重要的文献研究了病人频繁到急诊室就诊的原因。这项工作表明，社会人口学特征对理解患者重新就诊的原因很重要，但它没有提供频繁就诊意味着什么的定义。本文旨在找出与急诊科频繁就诊相关的个人和出诊因素。方法：对伦敦东南部一家教学医院2006-2007年的一年急诊科就诊数据进行分析。数据集在两个级别上进行了分析：个人患者级别和出诊级别。制作了描述数据集的频率和交叉表。结果：1年间82812例患者共117187人次来急诊就诊。每名患者平均就诊1.4次，其中46%是重复就诊。分析表明，在研究期间，更频繁地到急诊科就诊的患者在个人和就诊情况方面存在差异。患者概况的变化最早出现在第四次就诊时，随着就诊人数的增加，这种变化变得更加明显。经常出席者更有可能是男性(50.5%的单身出席者；69.5%的>；=10次出席)，年龄较大(单身出席，平均年龄32岁；>；=10次出席，平均年龄45.6岁)，白天以外时间参加(51.4%的单身出席；69.2%的>；=10次出席)，以及被分流到更严重的类别(36.1%的单身出席；54.3%的>；=10人次)。结论：在设计本地服务以转移频繁访问者的情况下，现有数据源可以成为丰富的信息来源，为服务设计提供信息。例如，这项分析发现，在检查这家特定医院的频繁就诊时，第四次或更多次就诊的老年男性可能是一个重要的群体。它还发现了在正常手术时间以外对服务的潜在需求，尽管经常就诊的人往往被分流到更紧急的类别。
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 >= 10 attendances), older (single attendance, mean age 32 years; >= 10 attendances, mean age 45.6 years), to attend outside daytime hours (51.4% of single attendances; 69.2% of >= 10 attendances) and to be triaged into the more serious categories (36.1% of single attendances; 54.3% of >= 10 attendances).Conclusion: 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.