Emergency department frequent users in rural Tuscany: who, why and how? A descriptive retrospective analysis

BACKGROUND : Emergency Department (ED) frequent users are very common in Italy although they are still poorly studied and not yet adequately defined. The purpose of this work was to categorize and assess this population in a rural setting. METHODS: A multi-center, retrospective study was conducted examining data of adult patients who attended three rural EDs during year 2018, including age, sex, triage code, presentation, diagnosis, outcome and ED length of stay (LO S). Patients with several visit requests higher than the 95th and 99th percentiles (N.=3 and N.=6) were categorized as frequent users and extreme frequent users and subsequently stratified by age. R RESULTS: A total of 57 190 ED visit requests by 38 860 people was included in the study. Frequent and extreme frequent users represented only 4.3% of patients but requested 15% of total visits. Frequent and extreme frequent users had an average age higher than the rest and were women with a slight prevalence. LO S showed substantial differences between occasional and frequent users. Considerable deviations resulted in triage priority, with a reduction of the minor codes and a simultaneous increase in the highest priority codes in frequent users. Frequent users had also higher percentages of admissions and transfers. CONCLUSIONS: Frequent and extreme frequent users are sensibly older; their impact on ED activities seem to be stronger, with longer paths and more complex clinical conditions. The reproducible nature of the stratification will allow in the future a comparison between EDs with different volumes of activity.