Frequent Presenters to Southern New Zealand Emergency Departments differ from other ED attenders

Objective

To compare patterns and characteristics of emergency department visits initiated by frequent presenters and other ED attenders.

Methods

We performed a quantitative retrospective data analysis of routinely collected ED data across three public hospitals within New Zealand’s Southern district. The study population comprised: (1) frequent presenters (i.e., patients who visited any of the EDs on 10 or more occasions in any continuous 365-day period between 01/01/2018 and 31/12/2022) and (2) all other ED presenters during the same period. We compared visit-based and per-person metrics characterising presentation flow, utilization patterns and demographics.

Results

Frequent presenters constituted 0.6% of all ED attenders (1259 out of 196136) and initiated 6.8% of all ED visits (32541 out of 479975). Visits by frequent presenters showed no seasonality or day-of-the-week patterns and occurred mostly during daylight hours. Frequent presenters differed from non-frequent presenters by having more clustered visits, shorter intervals between presentations, higher presentation severity (more visits were triaged urgent and above), more arrivals by ambulance and police, higher incomplete treatment rate, more referrals and short stay admissions.

Conclusion

Frequent presenters make a sizeable contribution to ED load in terms of visit numbers and urgency. The nature of differences between frequent and non-frequent presenters indicate greater and more complex health needs in the former cohort. At the same time the diversity of visits in the frequent presenters’ histories shows potential for redirecting some patients and/or presentations to other care providers.

Key findings

• Frequent presenters make a small portion of total patients, but contribute disproportionately to ED load. High visit numbers and greater acuity indicate more complex health needs in this cohort.

• Frequent presenters differ from other ED attenders by having more clustered visits, shorter intervals between presentations, higher presentation acuity (more visits triaged urgent and above), more arrivals by ambulance and police, higher incomplete treatment rate, and required more referrals and short stay admissions.

• Visits by frequent presenters showed no seasonality or day-of-the-week patterns and occurred mostly during daylight hours.