An observational pilot study: Prevalence and cost of high frequency emergency department users atO rebro University Hospital, Sweden

Abstract

Background There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU atO rebro University Hospital (O UH). Additionally, we will determine the factors and outcomes associated with being a HEDU. Methods This was a retrospective, observational cohort study of ED patients presenting toO UH, Sweden between 2018 19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was 4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4 7, 8 18 and 19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU. Findings Of allO UH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the O rebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen. Conclusion O UH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.