An analysis of frequent users of emergency care at an urban university hospital

Study objective: This study was designed to identify patients who frequently use the emergency department, compare them with the general ED population, and determine why they choose the ED over other sources of medical care. Methods: This study used a patient survey administered to a convenience sample of ED patients at an urban university teaching hospital and level I trauma center. "Frequent" ED patients were identified as having 2 ED visits within the previous month or 4 visits in the previous year. Patients with scheduled revisits or suture removals were excluded. No medical interventions were used in the study. Results: One hundred thirty-four of 6,523 ED patients were identified as frequent ED users and completed the survey. Seventy-three percent of the study group had a usual source of medical care other than the ED, and only 27% said they had difficulty in seeing a primary care physician. Sixty percent of visits by the study group were for existing or recurrent medical problems. Seventy-two percent of responders believed their chief complaint was moderately or very serious, and 59% thought they needed immediate attention. Participants had a 28% admission rate to the hospital compared with 16% for the general ED population during the study period. The study group was more likely to be black patients who have Medicare or Medicaid as their primary insurance and less likely to have workers' compensation. Conclusion: Frequent users of emergency care have access to other sources of primary care, but use the ED for complaints they believe are serious and need immediate attention. These patients often have chronic complaints and are more likely to be admitted to the hospital. Efforts to cut medical costs should not limit access to the ED, which often becomes an important source of medical care for such patients.