Emergency Department Superusers: An Analysis of the Highest Frequency Utilizers at an Urban County Hospital Open Access

Mathew, Anitha (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/7h149q02c?locale=en
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Abstract

Often defined as at least 20 visits in a year, high frequency Emergency Department (ED)
use accounts for less than one percent of ED patients but more than three percent of visits.
Few studies have evaluated ED superuse patterns in a largely urban, county hospital setting. This
study evaluated ED superusers at Grady Memorial Hospital, a large urban, public hospital in
Atlanta, Georgia. Using the Theory of Planned Behavior, the objectives of this study were to
describe the: (1) demographic characteristics of high ED utilizers at Grady in 2011, (2) ED visits
of these patients, and (3) factors are associated with the highest number of annual ED visits in
this population. Grady's electronic medical record was used to identify patients with at least 20
ED visits from January 1st to December 31st, 2011. Variables identified were patient age, sex,
and insurance, and total number of ED visits in 2011, as well as insurance used per visit, mode of
arrival, day of visit, triage acuity, chief complaint, ED length of stay (LOS), ED disposition, and
hospital LOS if admitted. Frequency percents were calculated for each variable, and ANOVA
testing was used to determine what factors were associated with more ED visits. Ninety-five
superusers, or just 0.1% of all ED patients, were identified for 2011, accounting for 2,747 visits,
or 2.5% of all visits. Superusers were largely male, middle aged, and publicly insured. Half
arrived to the ED on their own, while 40% utilized ambulance transport. Patients tended to be
mid- to lower acuity at triage, with a large proportion of pain-related and psychiatric complaints.
Compared with the general Grady population, these patients had lower rates of admission,
shorter hospital LOS, and longer ED LOS. Higher numbers of ED visits were associated with
having Medicaid, walking in or using public transportation to get to the ED, low acuity at triage,
hospital admission, and psychiatric complaints. Contrary to previous research, more than half of
superusers in this study were publicly insured, and admission was associated with more ED
visits.

Table of Contents

I. Introduction - 1

II. Literature Review - 4

III. Method - 13

IV. Results - 15

V. Discussion - 19

VI. Tables - 27

VII. References - 31

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