Frequent use of the hospital emergency department is indicative of high use of other health care services

Study objective: We sought to determine the proportion of emergency departm ent patients who frequently use the ED and to compare their frequency of us e of other health care services at non-ED sites. Methods: A computerized patient database covering ail ambulatory visits and hospital admissions at all care facilities in the county of Stockholm, Swe den, was used. Frequent ED patients were defined as those making 4 or more visits in a 12-month period. Results: Frequent users comprised 4% of total ED patients, accounting for 1 8% of the ED visits. The ED was the only source of ambulatory care far 13% of frequent versus 27% of rare ED users (1 ED visit). Primary care visits w ere made by 72% of frequent ED users versus 57% by rare ED visitors. The co rresponding figures for hospital admission were 80% and 36%, respectively. Frequent ED visitors were also more likely to use other care facilities rep eatedly: their odds ratio (adjusted for age and sex) was 3.43 (95% confiden ce interval [Ct] 3.10 to 3.78) for 5 or more primary care visits and 29.98 (95% CI 26.33 to 34.15) far 5 or more hospital admissions. In addition, hea vy users had an elevated mortality (standardized mortality ratio 1.55; 95% CI 1.26 to 1.90). Conclusion: High ED use patients are also high users of other health care s ervices, presumably because they are sicker than average. A further indicat ion of serious ill health is their higher than expected mortality. This kno wledge might be helpful for care providers in their endeavors to find appro priate ways of meeting the needs of this vulnerable patient category.