Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
CJEM. 2012 Sep;14(5):306-13. doi: 10.2310/8000.2012.120670.
Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits.
Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit-demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay-were analyzed and compared to data from the entire ED population for the same period.
Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (. < 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (. < 0.05). Patients left without being seen in 15.8% of visits.
High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.
在急诊科（ED）患者人群中，有一部分患者频繁就诊。本病历回顾旨在描述这部分人群，并确定减少 ED 频繁就诊的策略。
在城市三级保健中心，频繁就诊定义为 1 年内就诊 15 次或以上。分析比较了每位患者每次就诊的详细信息（人口统计学资料、就诊原因、出院诊断、到达方式、加拿大分诊及 acuity 量表（CTAS）评分、以及住院时间），并与同期 ED 所有患者的数据进行比较。
92 名患者共就诊 2390 次（25523 名患者，44204 次就诊）。该人群主要为男性（66%）和中年（中位数年龄 42 岁），无固定住址（27.2%）。59.3%的就诊患者是乘坐救护车到达，其 CTAS 评分较一般人群轻。物质使用占就诊原因的 26.9%。女性和异常生命体征与住院时间延长相关，而无固定住址和物质使用则与住院时间缩短相关（<.05）。与一般人群相比，该人群的入院率较低，而女性入院的可能性是男性的两倍（<.05）。15.8%的就诊患者未得到诊治就离开了。
高频 ED 用户更可能是男性、年轻、且住房不稳定，就诊原因多为物质使用。尽管该人群的入院率较低，但这些就诊的相关费用较高。减少就诊次数和改善该人群健康状况的干预措施似乎是合理的。
