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ED ‘Frequent Flyers’ More Likely to Die, Be Admitted Than Other Patients

EDMONTON, ALBERTA – Patients who regularly show up at emergency departments might be labeled “frequent flyers” and their complaints might be viewed with some suspicion, but a new Canadian study offers evidence that they should be taken very seriously.

The study, published online in Emergency Medicine Journal, suggests those patients are more than twice as likely as infrequent users to die, be admitted to hospital, or require other outpatient treatment. The analysis of available evidence was conducted by researchers from the University of Alberta in Edmonton.

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The report also notes that frequent users make up a substantial percentage of ED patients accounting for up to one in 12 patients seeking emergency care and around one in four of all visits.

The article was based on a search of seven electronic databases of research relating to the frequency and outcomes of ED use by adults. Out of a total of more than 4,000 potential studies, 31 relevant pieces of research published between 1990 and 2013 were included in the final analysis.

The studies defined frequent users as patients who visited EDs from four or more times up to 20 times a year. Based on seven studies looking at death rates, the analysis indicated that patients in those categories were more than twice as likely to die as those who rarely sought emergency care.

In addition, frequent users were around 2.5 times as likely to be admitted or to require at least one outpatient clinic visit as infrequent users.

"Our results suggest that, despite heterogeneity, frequent users are a distinct and high risk group," the authors write, suggesting a more targeted proactive approach to managing the cases.

One difficulty, they explain, is a lack of any consensus as to what constitutes a frequent user. That makes it difficult to compare patients and come up with recommendations.

“Frequent ED users appear to experience higher mortality, hospital admissions and outpatient visits compared with non-frequent users, and may benefit from targeted interventions,” the study concludes. “Standardized definitions to facilitate comparable research are urgently needed.”