van der Linden M Christien, van den Brand Crispijn L, van der Linden Naomi, Rambach Anna Hjh, Brumsen Caro
Emergency Department, Medical Centre Haaglanden, P,O, Box 432, 2501, CK The Hague, The Netherlands.
Int J Emerg Med. 2014 Feb 5;7(1):9. doi: 10.1186/1865-1380-7-9.
Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent visitors (FV) and highly frequent visitors (HFV) is necessary in order to plan more effective interventions.In the Netherlands, the incidence of high ED utilization is unknown. The purpose of this study was to investigate if the well-documented international high ED utilization also exists in the Netherlands and if so, to characterize these patients. Therefore, we assessed the proportion of FV and HFV; compared age, sex, and visit outcomes between patients with high ED utilization and patients with single ED visits; and explored the factors associated with high ED utilization.
A 1-year retrospective descriptive correlational study was performed in two Dutch EDs, using thresholds of 7 to 17 visits for frequent ED use, and greater than or equal to 18 visits for highly frequent ED use.
FV and HFV (together accounting for 0.5% of total ED patients) attended the ED 2,338 times (3.3% of the total number of ED visits). FV and HFV were equally likely to be male or female, were less likely to be self-referred, and they suffered from urgent complaints more often compared to patients with single visits. FV were significantly older than patients with single visits and more often admitted than patients with single visits. Several chief complaints were indicative for frequent and highly frequent ED use, such as shortness of breath and a psychiatric disorder.
Based on this study, high ED utilization in the Netherlands seems to be less a problem than outlined in international literature. No major differences were found between FV and HFV, they presented with the same, often serious, problems. Our study supports the notion that most patients with high ED utilization visit the ED for significant medical problems.
急诊科（ED）高就诊率患者占急诊就诊总数的比例过高。现有关于急诊科高就诊率的研究对频繁就诊的急诊患者的同质性提出了质疑。为了制定更有效的干预措施，有必要关注频繁就诊者（FV）和高度频繁就诊者（HFV）亚组之间的差异。在荷兰，急诊科高就诊率的发生率尚不清楚。本研究的目的是调查荷兰是否也存在国际上有充分记录的急诊科高就诊率情况，如果存在，对这些患者进行特征描述。因此，我们评估了FV和HFV的比例；比较了高急诊科就诊率患者与单次急诊科就诊患者的年龄、性别和就诊结局；并探讨了与高急诊科就诊率相关的因素。
在两家荷兰急诊科进行了一项为期1年的回顾性描述性相关性研究，频繁急诊科就诊的阈值为7至17次就诊，高度频繁急诊科就诊的阈值为大于或等于18次就诊。
FV和HFV（共占急诊患者总数的0.5%）就诊急诊科2338次（占急诊就诊总数的3.3%）。FV和HFV的男女比例相同，自我转诊的可能性较小，与单次就诊患者相比，他们更常出现紧急情况。FV的年龄显著大于单次就诊患者，住院的频率也高于单次就诊患者。一些主要症状表明存在频繁和高度频繁的急诊科就诊情况，如呼吸急促和精神障碍。
基于本研究，荷兰急诊科高就诊率问题似乎没有国际文献中描述的那么严重。FV和HFV之间未发现重大差异，他们存在相同的、通常较为严重的问题。我们的研究支持这样一种观点，即大多数急诊科高就诊率患者因严重的医疗问题前往急诊科就诊。
