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Wu J, Siddiqui FJ, Mak CCM, Chua ISY, Thangayah JR, Tan EXX, Seet HY, Rao AK, Tan HY, Mohamed A, Hartman M, Leong BSH, Ong MEH, Mao DR. Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol. BMC Health Serv Res 2024; 24:256. [PMID: 38419049 PMCID: PMC10900701 DOI: 10.1186/s12913-023-10516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy-in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions. METHODS Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores. DISCUSSION Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT's efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model's prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations. TRIAL REGISTRATION ClinicalTrials.gov, NCT04447079. Initiated on 25 June 2020.
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Affiliation(s)
- Juntian Wu
- Health Services Research Centre, SingHealth, Outram, Singapore.
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore.
| | - Fahad Javaid Siddiqui
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Outram, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Buangkok, Singapore
| | - Ivan Si Yong Chua
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
| | | | - Esther Xi Xiang Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Jurong East, Singapore, Singapore
| | - Huey Ying Seet
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Adriel Kailing Rao
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Hann Yee Tan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Asif Mohamed
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Novena, Singapore
| | - Mikael Hartman
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Department of Surgery, National University Hospital, Kent Ridge, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Kent Ridge, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
- Unit for Pre-hospital Emergency Care, Ministry of Health, Outram, Singapore
| | - Desmond Renhao Mao
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
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2
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Zhou JG, Cameron PA, Dipnall JF, Shih K, Cheng I. Using network analyses to characterise Australian and Canadian frequent attenders to the emergency department. Emerg Med Australas 2023; 35:225-233. [PMID: 36216495 DOI: 10.1111/1742-6723.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore and compare the characteristics of frequent attenders to the ED at an Australian and a Canadian tertiary hospitals by utilising a network analysis approach. METHODS We conducted a retrospective population-based study using administrative data over the 2018 and 2019 calendar years. Participants were from a tertiary hospital in Melbourne, Australia, and Toronto, Canada. Frequent attenders were defined as patients with four or more visits in 12 months. Characteristics of younger (18-39 years), middle-aged (40-69 years) and older (70 years and older) frequent attenders were described using descriptive statistics and network analyses. RESULTS Younger frequent attenders were characterised by mental illness and substance use, while older frequent attenders had high rates of physical (including chronic) diseases. Middle-aged frequent attenders were characterised by a combination of mental and physical illnesses. These findings were observed at both hospitals. Across all age groups, the network analyses between the Melbourne and Toronto hospitals were different. Among older frequent attender visits, more diagnoses were associated with high triage acuity at the Toronto hospital than at the Melbourne hospital. Some associations were similar at both sites, for example, the negative correlation between high triage acuity and joint pain. CONCLUSION Younger, middle-aged and older frequent attenders have distinct characteristics, made readily apparent by using network analyses. Future interventions to reduce ED visits should consider the heterogeneity of frequent attenders who have needs specific to their age, presenting problems and jurisdiction.
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Affiliation(s)
- Jonathan G Zhou
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Joanna F Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Kingsley Shih
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Goh P, Md Amir Ali LAB, Ou Yong D, Ong G, Quek J, Banu H, Wu JT, Mak CCM, Mao DR. Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10795. [PMID: 36078521 PMCID: PMC9518548 DOI: 10.3390/ijerph191710795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. METHODS Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. RESULTS All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. CONCLUSION ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.
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Affiliation(s)
- Pamela Goh
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | | | - Donovan Ou Yong
- Emergency Department, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Gabriel Ong
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jane Quek
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Halitha Banu
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jun Tian Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore 539747, Singapore
| | - Desmond Renhao Mao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, Singapore 768828, Singapore
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4
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Pek PP, Lau CY, Sim X, Tan KB, Mao DRH, Liu Z, Ho AF, Liu N, Ong MEH. Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:483-492. [PMID: 36047523 DOI: 10.47102/annals-acadmedsg.2021483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. METHODS We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. RESULTS We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. CONCLUSION A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
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5
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Kuan WS, Chua MT. Frequent attenders to multiple emergency departments in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:460-461. [PMID: 36047520 DOI: 10.47102/annals-acadmedsg.2022216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore
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Emergency department utilisation among older adults—Protocol for a systematic review of determinants and conceptual frameworks. PLoS One 2022; 17:e0265423. [PMID: 35661153 PMCID: PMC9166351 DOI: 10.1371/journal.pone.0265423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Older adults aged 65 years and above have a disproportionately higher utilization of emergency healthcare, of which Emergency Department (ED) visits are a key component. They experience higher degree of multimorbidity and mobility issues compared to younger patients, and are consequently more likely to experience a health event which requires an ED visit. During their visit, older adults tend to require more extensive workup, therefore spending a greater amount of time in the ED. Compared to the younger population, older adults are more susceptible to adverse events following discharge. Considering these factors, investigating the determinants of ED utilisation would be valuable. In this paper, we present a protocol for a systematic review of the determinants of ED utilisation among communitydwelling older adults aged 65 years and above, applying Andersen and Newman’s model of healthcare utilisation. Furthermore, we aim to present other conceptual frameworks for healthcare utilisation and propose a holistic approach for understanding the determinants of ED utilisation by older persons. Methods The protocol is developed in accordance with the standards of Campbell Collaboration guidelines for systematic reviews, with reference to the Cochrane Handbook for Systematic Review of Interventions. Medline, Embase and Scopus will be searched for studies published from 2000 to 2020. Studies evaluating more than one determinant for ED utilisation among older adults aged 65 years and above will be included. Search process and selection of studies will be presented in a PRISMA flow chart. Statistically significant (p < 0.05) determinants of ED utilisation will be grouped according to individual and societal determinants. Quality of the studies will be assessed using Newcastle Ottawa Scale (NOS). Discussion In Andersen and Newman’s model, individual determinants include predisposing factors, enabling and illness factors, and societal determinants include technology and social norms. Additional conceptual frameworks for healthcare utilisation include Health Belief Model, Social Determinants of Health and Big Five personality traits. By incorporating the concepts of these models, we hope to develop a holistic approach of conceptualizing the factors that influence ED utilisation among older people. Systematic review registration This protocol is registered on 8 May 2021 with PROSPERO’s International Prospective Register of Systematic Reviews (CRD42021253770).
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Liu Z, Mao DRH, Fook-Chong S, Mak CCM, Tan XXE, Wu JT, Tan KB, Ong MEH, Siddiqui FJ. Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016. Drug Alcohol Rev 2022; 41:1236-1244. [PMID: 35437844 DOI: 10.1111/dar.13472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016. METHODS Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity. RESULTS Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits. DISCUSSION AND CONCLUSIONS Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.
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Affiliation(s)
- Zhenghong Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Stephanie Fook-Chong
- Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Xi Xiang Esther Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jun Tian Wu
- Health Services Research Centre, SingHealth, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kelvin B Tan
- Future Systems Office, Infocomms, Technology and Data Group, Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad J Siddiqui
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Tang XR, Pek PP, Siddiqui FJ, Malhotra R, Kwan YH, Tiah L, Ho AFW, Ong MEH. Determinants of emergency department utilisation by older adults in Singapore: A systematic review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:170-179. [PMID: 35373240 DOI: 10.47102/annals-acadmedsg.2021437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Adults aged ≥60 years contribute to disproportionately higher visits to the emergency departments (ED). We performed a systematic review to examine the reasons why older persons visit the ED in Singapore. METHODS We searched Medline, Embase and Scopus from January 2000 to December 2021 for studies reporting on ED utilisation by older adults in Singapore, and included studies that investigated determinants of ED utilisation. Statistically significant determinants and their effect sizes were extracted. Determinants of ED utilisation were organised using Andersen and Newman's model. Quality of studies was evaluated using Newcastle Ottawa Scale and Critical Appraisal Skills Programme. RESULTS The search yielded 138 articles, of which 7 were used for analysis. Among the significant individual determinants were predisposing (staying in public rental housing, religiosity, loneliness, poorer coping), enabling (caregiver distress from behavioural and psychological symptoms of dementia) and health factors (multimorbidity in patients with dementia, frailty, primary care visit in last 6 months, better treatment adherence). The 7 included studies are of moderate quality and none of them employed conceptual frameworks to organise determinants of ED utilisation. CONCLUSION The major determinants of ED utilisation by older adults in Singapore were largely individual factors. Evaluation of societal determinants of ED utilisation was lacking in the included studies. There is a need for a more holistic examination of determinants of ED utilisation locally based on conceptual models of health seeking behaviours.
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Affiliation(s)
- Xuan Rong Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abidova A, da Silva PA, Moreira S. Understanding Complaints in the Emergency Department. Health Serv Insights 2021; 14:11786329211057351. [PMID: 34898988 PMCID: PMC8655438 DOI: 10.1177/11786329211057351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this research is to identify the main determinants of patients’ complaints and potential mediators and moderators in this regard. This research shows that complaints can result from a complex set of processes involving direct, mediating, and moderating effects. Interventions aimed at reducing patients’ complaints should consider specific patient groups and experiences.
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Affiliation(s)
- Alina Abidova
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Sérgio Moreira
- Faculty of Psychology, University of Lisbon, Lisbon, Portugal
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Hu Z, Siddiqui FJ, Fan Q, Lian SWQ, Liu N, Ong MEH. Trends of chronic illness in emergency department admissions among elderly adults in a tertiary hospital over ten years. BMC Health Serv Res 2021; 21:1305. [PMID: 34863159 PMCID: PMC8645127 DOI: 10.1186/s12913-021-07309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to determine to what extent an aging population and shift to chronic illness has contributed to emergency admissions at a tertiary care hospital over ten years. Methods This was a retrospective observational study performed using a database of all emergency admissions from the Emergency Department (ED) at a single tertiary hospital in Singapore during a ten-year period (January 1st, 2008 to December 31st, 2017). Emergency admissions were defined as ED visits with inpatient admission as the disposition. This study analyzed the trends of demographics, pre-existing comorbidities, chronic conditions or ambulatory care sensitive conditions (ACSC) of all patients who underwent emergency admissions in Singapore General Hospital. Results A total of 446,484 emergency records were included. For elderly patients, the proportions of them had pre-existing multimorbidity at the time of undergoing emergency admissions were found to be lower at the end the 10-year study period relative to the beginning of the study period. The proportions of emergency admissions whose ED primary diagnoses were categorized as chronic conditions and certain chronic ACSC including chronic obstructive pulmonary disease, congestive heart failure, diabetes complications, and epilepsy also decreased for elderly patients over the 10-year study period. Conclusions In Singapore, despite a rapidly aging population, there have been surprisingly lower proportions of chronic conditions, pre-existing comorbidities, and chronic ACSC among the elderly emergency admissions. This is possibly consistent with an overall improved management of the chronic conditions among the elderly population. Future studies should include similar studies at the national level and comparison with other healthcare settings in different countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07309-z.
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Affiliation(s)
- Zhongxun Hu
- Duke-NUS Medical School, Singapore, Singapore.
| | - Fahad Javaid Siddiqui
- Prehospital and Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Qiao Fan
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Sherman W Q Lian
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Liu
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Prehospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore
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Greenfield G, Okoli O, Quezada-Yamamoto H, Blair M, Saxena S, Majeed A, Hayhoe B. Characteristics of frequently attending children in hospital emergency departments: a systematic review. BMJ Open 2021; 11:e051409. [PMID: 34663662 PMCID: PMC8523960 DOI: 10.1136/bmjopen-2021-051409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. SETTING Hospital EDs. PARTICIPANTS Children <21 years, attending hospital EDs frequently. PRIMARY OUTCOME MEASURES Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. RESULTS We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a 'frequent ED' usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. CONCLUSIONS The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.
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Affiliation(s)
- Geva Greenfield
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Olivia Okoli
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Harumi Quezada-Yamamoto
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Benedict Hayhoe
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Binnie V, Le Brocque R, Jessup M, Johnston ANB. Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review. Australas Emerg Care 2020; 24:264-279. [PMID: 33358578 DOI: 10.1016/j.auec.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Extensive literature reports the influence of childhood adversity on adult health, however few studies have explored these life antecedents in people who frequently present to the emergency department. This review synthesizes literature exploring childhood adversity influences on emergency department presentations, if and how it is identified, and interventions addressing the health care needs of this group. METHODS Eight electronic databases were searched. Arksey and O'Malley's framework guided this review, and a quality appraisal was undertaken. Searches included all published studies until August 2020. RESULTS Twenty-one articles were included in this review. They revealed that childhood adversity is common among adults who frequently attend the emergency department. It impacts physical and psychological health into adulthood and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood. CONCLUSIONS Several studies call for screening, intervention, and education to identify and address impacts of childhood adversity for patients who frequently present to the emergency department. However, reliable high-level studies exploring these topics specific to the emergency department are uncommon. Consequently, definitive interventions to address the healthcare needs of this group is lacking and warrants further research.
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Affiliation(s)
- Vicki Binnie
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia.
| | - Robyne Le Brocque
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Melanie Jessup
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Amy N B Johnston
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Qld, 4102, Australia
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13
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Afonso S, Lopes S. Differences in Clinical Characteristics and Utilization of Emergency Department by High-Frequency Users. J Emerg Med 2020; 59:153-160. [PMID: 32349880 DOI: 10.1016/j.jemermed.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/01/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Sandra Afonso
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Center, Lisbon, Portugal
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Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments. Emerg Med Int 2020; 2020:8289275. [PMID: 32104605 PMCID: PMC7036124 DOI: 10.1155/2020/8289275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding, resulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent attenders of EDs examine general patients without classifying certain subgroups. This study aimed to investigate patients with liver cirrhosis who present repeatedly to the ED. Methods This was a retrospective, observational cohort study of adult patients with a history of liver cirrhosis presenting to the ED from January 2011 to December 2015. We included patients with cirrhosis whose first ED visit occurred during the study period. We went far back for 20 years and excluded patients with any ED visits (including both cirrhosis and noncirrhosis-related ones) before the study period. We categorized frequent attenders as patients with more than 4 ED visits within 12 months after the first ED visit; infrequent attenders were those who did not meet this criterion. Results A total of 3513 patients with cirrhosis were included in this retrospective cohort study. Compared with the infrequent attenders, frequent attenders had a higher rate of presentations due to hepatic encephalopathy (15.2% vs 13.7%, P < 0.001) and ascites (10% vs 4%, P < 0.001) and ascites (10% vs 4%, P < 0.001) and ascites (10% vs 4%. Conclusions Hepatic encephalopathy and ascites account for more ED visits in frequent than in infrequent attenders. Our findings provide information for those planning outpatient support for patients with cirrhosis. Further research is warranted.
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Tan AL, Iyer NG, Putri N, Nadkarni N, Skanthakumar T, Wong TH, Tay GCA. Factors driving frequent attendance at emergency departments for patients with head and neck cancer. Head Neck 2019; 41:3798-3805. [PMID: 31423688 DOI: 10.1002/hed.25916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/28/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer have a higher risk of emergency department (ED) frequent attender (FA). We hypothesized that FAs present with issues different from non-FAs. METHODS A retrospective cohort study was conducted on Singapore residents with head and neck cancers using de-identified registry merged with electronic medical record data. A competing risk regression analysis was performed to identify factors associated with FA. Aggregated primary diagnoses were compared for patients with and without FA risk factors. RESULTS Thirteen percent of patients with head and neck cancer were FAs. FA risk factors were Charlson comorbidity index (3+), and socioeconomic status (SES). FAs had a higher proportion of respiratory infections. The spectrum of diagnosis was similar for patients with low and high SES. Current smokers had a greater proportion of respiratory complaints, relative to never smokers. CONCLUSION Patients with greater comorbidity scores or higher SES were more likely to be FA. FAs were more likely to present with respiratory complaints, likely related to cancer treatment, or smoking status.
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Affiliation(s)
- Aidan L Tan
- Preventive Medicine, National University Hospital, Singapore.,Health Services Research Unit, Singapore General Hospital, Singapore
| | - Narayanan Gopalakrishna Iyer
- Health Services Research Unit, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore
| | - Natascha Putri
- Division of Surgical Oncology, National Cancer Centre, Singapore.,Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore
| | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | | | - Ting Hway Wong
- General Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Gerald Ci An Tay
- Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore.,General Surgery, Singapore General Hospital, Singapore
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Fernández Alonso C, Aguilar Mulet JM, Rivas García A, González Armengol JJ. [We can call hiper frequent users to the patients with the highest number of attention in emergencies and primary care]. Aten Primaria 2018; 51:50-51. [PMID: 30287086 PMCID: PMC6837118 DOI: 10.1016/j.aprim.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Juan Mariano Aguilar Mulet
- Servicio de Urgencias, Hospital Universitario de La Princesa, Madrid, España; Grupo de Trabajo del Paciente Fidelizado, Plan Estratégico de Urgencias de la Comunidad de Madrid, Madrid, España
| | - Arístides Rivas García
- Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Juan Jorge González Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Servicio de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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Wong TH, Lau ZY, Ong WS, Tan KB, Wong YJ, Farid M, Teo MCC, Yee ACP, Nguyen HV, Ong MEH, Iyer NG. Cancer patients as frequent attenders in emergency departments: A national cohort study. Cancer Med 2018; 7:4434-4446. [PMID: 30117313 PMCID: PMC6144141 DOI: 10.1002/cam4.1728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer-related hospitalization. METHODS A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12-month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan-Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses. RESULTS Records for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28-3.74; 75-84 years, HR 1.29, 95% CI 1.16-1.45; and ≥85 years, HR 1.71, 95% CI 1.45-2.02, relative to age 55-64), male gender (HR 1.26, 95% CI 1.16-1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19-1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23-1.59; housing subsidy type, HR 2.12, 95% CI 1.77-2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67-3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27-3.31; hypopharynx, HR 2.72, 95% CI 1.56-4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13-2.18; pleural, HR 3.69, 95% CI 2.12-6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26-2.74; esophagus, HR 4.13, 95% CI 2.78-6.13), hepato-pancreato-biliary (liver, HR 1.42, 95% CI 1.01-2.00, pancreas, HR 2.48, 95% CI 1.72-3.59), and certain hematological malignancies (diffuse non-Hodgkin's lymphoma, HR1.59, 95% CI 1.08-2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21-2.86). Brain (HR 1.69, 95% CI 1.27-2.26), lung (HR 1.31, 95% CI 1.01-1.71), liver (HR 1.46, 95% CI 1.14-1.89), and bone (HR 1.35, 95% CI 1.04-1.76) metastases were also associated with FA. CONCLUSION There are cancer-specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high-risk groups and prevent unnecessary ED use.
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Affiliation(s)
- Ting Hway Wong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Zheng Yi Lau
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | | | - Kelvin Bryan Tan
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
- Saw Swee Hock School of Public HealthSingaporeSingapore
| | - Yu Jie Wong
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | - Mohamad Farid
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Melissa Ching Ching Teo
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Alethea Chung Pheng Yee
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Hai V. Nguyen
- School of PharmacyMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Marcus Eng Hock Ong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - N. Gopalakrishna Iyer
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
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Kuek BJW, Li H, Yap S, Ng MXR, Ng YY, White AE, Ong MEH. Characteristics of Frequent Users of Emergency Medical Services in Singapore. PREHOSP EMERG CARE 2018; 23:215-224. [PMID: 30118627 DOI: 10.1080/10903127.2018.1484969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aims to describe frequent users of Emergency Medical Services (EMS) conveyed to a Singapore tertiary hospital, focusing on a comparison between younger users (age <65) and older users in diagnoses and admission rates. METHODS All patients conveyed by EMS to a tertiary hospital 4 times or more over a 1-year period in 2015 had their EMS ambulance charts and Emergency Department (ED) electronic records retrospectively analyzed (n = 243), with admission the primary outcome. RESULTS The 243 frequent users were analyzed with a combined total of 1,705 visits, out of a total of 10,183 patients with 12,839 visits conveyed by EMS to Singapore General Hospital (SGH) in 2015. Younger frequent users (<65 years age) were found to be predominantly male (79.6%, p = 0.001) and were on average responsible for more visits than elderly frequent users (8.6 vs. 5.7, p = 0.004). Medical co-morbidities were significantly more prevalent in older users. Younger frequent users were more likely to be smokers (60.2% vs. 22.3%), heavy drinkers (51.3% vs. 8.5%), substance abusers (12.4% vs. 0.8%), and bad debtors (49.6% vs. 20.0%, p < 0.001). A larger proportion presented with altered mental states (11.7% vs. 5.4%, p < 0.001) and alcohol related diagnoses (34.7% vs. 5.3%, p < 0.001). Many were picked up from public areas (45.5% vs. 19.6%, p < 0.001), and had lower acuity triage scores at both EMS (p < 0.001) and ED (p = 0.001). They had lower admission rates (40.5% vs. 78.7%, p < 0.001) and shorter length of stay (4.3 vs. 5.9 days, p < 0.001). Univariable and multivariable analysis showed alcohol related diagnoses, history of alcohol abuse and lower triage scores were less likely to require admissions. CONCLUSION Frequent EMS users consume a disproportionate amount of healthcare resources. Two broad subgroups of patients were identified: younger patients with social issues and older patients with multiple medical conditions. EMS usage by older patients was significantly associated with higher rates of admission.
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Shen Y, Teo EWK, Liu N, Lam SW, Hock MOE. Data-Driven Approach to Defining the Emergency Department Frequent Attender Using a Cohort of 10 Years. J Acute Med 2018; 8:6-16. [PMID: 32995196 DOI: 10.6705/j.jacme.201803_8(1).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aims To identify, based on the measure of resource utilization, the number of visits per calendar year that defines the emergency department (ED) frequent attender; and examine for significant trends in patient characteristics and outcomes which may support the use of our definition. Materials and Methods We conducted a retrospective observational study of electronic clinical records of all ED visits over a 10-year period from January 2005 to December 2014 to an urban tertiary general hospital. We defined the ED frequent attender based on the number of ED attendances per calendar year which would yield a patient group representing more than 20% of all patient visits. Chi-square tests were conducted on each categorical factor individually to assess if they were independent of time, and the Student's t-test was used to assess continuous variables on their association with being a frequent attender. Results 1.381 million attendance records were analyzed. Patients who attended three or more times per year accounted for about 22.1% of all attendances and were defined as frequent attenders. They were associated with higher triage acuity, complex chronic illnesses, greater 30-day mortality for patients with three to six visits, and increased markers of resource utilization, such as ambulance use (15.5% vs. 11.6%), time to disposition (180 vs. 155 minutes), admissions rate (47.4% vs. 30.7%) and inpatient length of stay (6 days vs. 4 days). All p values were statistically significant (p < 0.001). Conclusion We have demonstrated a data-driven approach to defining an ED frequent attender. Frequent attenders are associated with increased resource utilization, more complex illness and may be associated with greater 30-day mortality rates.
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Affiliation(s)
- Yuzeng Shen
- Singapore General Hospital Department of Emergency Medicine Singapore
| | | | - Nan Liu
- Singapore General Hospital Department of Emergency Medicine Singapore
| | - Shao Wei Lam
- SingHealth Health Services Research Centre Singapore
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Chan JSE, Tin AS, Chow WL, Tiah L, Tiru M, Lee CE. Frequent attenders at the emergency department: an analysis of characteristics and utilisation trends. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817715271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Frequent attenders (FAs) place a disproportionate burden on emergency department (ED) resources. Objectives: Our study aimed to describe characteristics of ED visits by FAs to our hospital so as to identify potential strategies to better manage ED demand. Methods: This was a retrospective observational study. All visits to the ED from 1 January 2011 to 31 December 2011 were included. FAs were defined as patients with ⩾5 visits to the ED over the study period. They were further stratified by visit frequency. Results: FAs showed a bimodal age distribution, with visits by FAs aged 16–25 years old and the elderly aged 66 years and above accounting for the largest proportion of ED visits relative to the number of visits by their non-FA counterparts. Using the age group of 26–45 years as reference, the odds ratio (OR) of FAs being 16–25 years old was 3.037 (95% confidence interval (CI) 2.708–3.407, p < 0.001). Above the age of 65, the OR of FAs falling into a given age group increased for every additional decade of life, up to 3.118 (2.495–3.898, p <0.001) for the age group of 86 and above. FAs were more likely to be male. Diagnoses which accounted for a higher percentage of visits with increasing visit frequency were asthma, chronic obstructive pulmonary disease, upper respiratory tract infection and headache. Conclusions: FAs include the high-acuity chronic sick as well as young adults with low-acuity complaints. Disease optimisation programmes, case management, robust community-based healthcare and public education are possible avenues to optimise ED resources in an ageing society.
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Affiliation(s)
| | - Aung Soe Tin
- Health Services Research, Eastern Health Alliance, Tampines Plaza, Singapore
| | - Wai Leng Chow
- Health Services Research, Eastern Health Alliance, Tampines Plaza, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Mohan Tiru
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Chien Earn Lee
- Chief Executive’s Office, Changi General Hospital, Singapore
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Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy. J Am Med Dir Assoc 2016; 17:671.e1-7. [DOI: 10.1016/j.jamda.2016.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/24/2022]
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