Defining "high-frequency" emergency department use: Does one size fit all for urban and rural areas?

OBJECTIVE: To suggest a functional definition for identification of "high-frequency" emergency department (ED) users in rural areas. DESIGN: Retrospective analysis of secondary data. SETTING: Sioux Lookout Meno Ya Win Health Centre in northwestern Ontario. PARTICIPANTS: All ED visitors (N = 7121) in 2014 (N = 17 911 visits) in one rural hospital. MAIN OUTCOME MEASURES: The number of patients and visits identified using different definitions of high-frequency use. RESULTS: By using the most common definition of high-frequency use (≥ 4 annual visits) for our hospital data, we identified 16.7% of ED patients. Using 6 or more annual visits as the definition, we identified 7.9% of ED patients; these patients accounted for 31.3% of the ED visit workload. Using the definition of 6 or more identifies less than 10% of the patients, which is a similar result to using the lower visit standard (≥ 4) in urban centres. CONCLUSION: We suggest that the definition for high-frequency visitors to a rural ED should be 6 or more annual visits. Other useful subsets might include very high-frequency users (12 to 19 annual visits) and super users (≥ 20 annual visits).

A 5 year retrospective study of emergency department use in Northwest Ontario: a measure of mental health and addictions needs.

OBJECTIVE: The main objective of this study was to understand the five-year trend in total emergency department (ED) visits, frequency of use, and diagnoses and disposition of patients. Since the region has experienced a profound increase in opioid use disorder since 2009, we were particularly interested in changes in the volume of mental health and addiction (MHA) ED presentations. METHODS: Retrospective aggregate data analysis of ED visits to the Sioux Lookout Meno Ya Win Health Centre 2010-2014. RESULTS: ED visit volume increased 29% over the five-year study period, while MHA ED visits increased 73%. The admission rate remained stable at 6.9% of ED visits. Five-year trends in clinically grouped diagnostic categories identified respiratory, MHA, and abdominal/pelvic complaints as the three most common ED presentations. In 2014, MHA presentations accounted for 10.3% of ED visits, 8.7% of admissions, and 20.0% of inter-hospital transfers. CONCLUSION: The dramatic increase in MHA ED visits mirrors the opioid epidemic the region is experiencing. MHA may soon become the commonest ED presentation. If reasons for ED visits serve as a proxy for unmet outpatient needs, increased efforts at developing community MHA services and addressing the related social determinants of health are required.