Characteristics of individuals who frequently use emergency departments in Hong Kong: a regionbased cohort study

Abstract

Introduction: This study analysed the characteristics and healthcare needs of emergency department (ED) users, and identified factors that contribute to frequent ED use. Methods: Using the Clinical Data Analysis and Reporting System of the Hospital Authority, we identified all patients and visits to three EDs in the New Territories West Cluster from 1 April 2018 to 31 March 2019. Individuals with 4 to 9 ED visits and ≥10 ED visits were defined as frequent users (FUs) and high-intensity users (HIUs), respectively; they were compared with normal users (NUs, 1-3 visits) in terms of demographics, underlying disease, and outcomes. Visits by these users were also compared in terms of demographics, urgency, investigations performed, nature of complaint, and admission statistics. Results: In total, FUs and HIUs constituted 9% of ED users but represented 27.2% of all visits. Compared with NUs, FUs and HIUs were older, more likely to have a payment exemption, and more likely to have underlying physical and mental health disorders. Compared with NUs, FUs were more likely to require ambulance services (17.9% vs 23.9%; P<0.001), be triaged as urgent or above (31.8% vs 38.1%; P<0.001), and require hospitalisation (28.5% vs 35.7%; P<0.001). Conclusion: Individuals who frequently use EDs are more likely to be in poor health and require medical attention. Additional community-or ED-based support systems for discharge planning and support, along with reduced barriers to alternative sources of care, would improve health in these individuals and help reduce ED utilisation burden.