High consumers of health care in emergency units: how to improve their quality of care.

Patients with non-urgent complaints and/or who attend frequently account for a substantial portion of the visits to emergency units. These patients usually require other types of care than that provided by a highly specialized emergency department (ED). In this paper we describe the development of ED utilization in the catchment area of Huddinge University Hospital, and the attempts made to improve the quality of care for high consumers of ED care. In a trial, nurse's advice and referral proved to be a feasible means of referring patients with non-urgent complaints from the hospital emergency department to more appropriate care sources, such as primary health care centres. A long-term follow-up showed that without any intervention, frequent ED users are a high-risk group as regards morbidity and mortality, especially with respect to suicide. Prevention with comprehensive and continuous treatment programmes should therefore be planned when a tendency is noted for patients to attend the ED frequently.