18
Barriers and Service for Frequent Emergency Department Users
Objectives: This study aimed to understand why frequent ED users present to the ED, what barriers to care exist, and what service offerings may be helpful to these patients.
Methods: We performed a prospective study of frequent ED users in an adult only urban level 1 trauma center with an annual census of approximately 120,000 visits per year. Participants were administered a piloted and pretested structured interview by a trained researcher querying demographics, ED usage, perceived barriers to care, and potential aids to maintaining health.
Results:Of 1,523 screened patients, 19.5% (297) were identified as frequent ED users. One-hundred ninety-seven (197) frequent ED users were excluded or declined study participation. One hundred frequent ED users were enrolled. The mean age was 48 years (95%CI 45-51). The majority of subjects were female (64%, 64/100, 95%CI 55-73%), white (61%, 60/98, 95%CI 52-71%) and insured by Medicaid (55%, 47/86, 95%CI 44-65%), Medicare (23%, 20/86, 95%CI 14-32%), or both (9%, 8/86, 95%CI 3-15%). On average, the subjects had 8 ED visits, 2 inpatient admissions, and 1 observation visit in the past 12-months at this hospital. Most frequent ED users (61%, 59/96, 95%CI 52-71%) stated the primary reason for their visit was that they felt that their health problem could only be treated in an ED. Taking time away from work or family commitments to receive health care and remembering to schedule annual preventative care were the most commonly cited barriers to care (15% (14/96, 95%CI 8-22%) and 16% (15/96, 95%CI 8-23%), respectively). Subjects stated that “after-hours options, besides the ED for minor health issues” (63%, 60/95, 95%CI 53-73%) and having “a nurse to work with you one-on-one to help manage health care needs” (53%, 50/95, 95%CI 43-63%) would be most helpful. Surveyed patients reported an average of 5 chronic conditions.
Conclusion: This survey of frequent ED users identified several opportunities to better serve this population. Frequent ED users believe their health concerns are emergent, and are not always able to take time away from their daily commitments to receive medical care, even in the face of multiple co-morbid conditions. Despite frequent health care contacts, this population does not always receive preventative health care. These challenges can exacerbate health problems, and result in additional health care utilization and expenditure. By understanding why frequent ED users present to the ED and what barriers to care exist, health systems can begin to address unmet needs that prevent wellness in this population.