Differences in clinical characteristics and utilization of emergency department by high-frequency users

Background: Knowing the distinctive features of patients with the highest utilization of the emergency department (ED) is paramount to finding adequate alternatives to ED care for selected patients and improving health care quality and efficiency. Objective: This study aimed to identify ED high-frequency users and compare their clinical and utilization characteristics with other ED users. Methods: Secondary data analysis of ED visits and patients database from a Portuguese public urban hospital. Retrospective study of adults visiting the ED in 2016 (61,403 patients; 95,643 visits), comparing demographic and clinical characteristics of patients and clinical and temporal characteristics of ED visits between high-frequency users (>10 ED visits in 2016) and frequent (4–10 ED visits) and nonfrequent (1–3 ED visits) users. Results: We identified 169 high-frequency users (0.3% of patients and 3.0% of ED visits) with an average number of 16.9 visits in 2016. Patients in this group were older (61.8 years; frequent users: 61.2 years; nonfrequent users: 53.4 years; p < 0.01) and required immediate and mental health care more frequently (18.6% of high-frequency users, 17.4% of frequent users, 13.5% of nonfrequent users, and 6.6%; 3.3%, 2.3%; p < 0.01). High-frequency users also used the ED for nonurgent reasons more than remaining groups (6.1%, 3.5%, 3.1%; p < 0.01). Conclusion: High-frequency users are an aged and heterogeneous group, requiring tailored interventions to improve care.