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
About this Master's Thesis
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