‘Hello, you’ve looked after me before’. Service use by older people with very frequent emergency department attendance.

Ms Debra Berry1,3, Dr  Maryann  Street1,2,3, Professor Julie Considine1,2,3
11 Deakin University, School of Nursing and Midwifery, Geelong, Australia, 2Deakin University, Centre for Quality and Patient Safety Research, Geelong, Australia, 3Deakin University, Centre for Quality and Patient Safety Research – Eastern Health Partnership, Box Hill, Australia

Background: Frequent attendance to emergency departments (EDs) is a common feature of health services worldwide and by all patient groups, including older people. The aims of this study were to i) identify the characteristics and outcomes of older people with very frequent ED use, and ii) examine their health and community services use 12 months pre- and post-index ED visit.
Methods: A retrospective cohort study was conducted at three EDs within one large metropolitan Australian health service. Older people, aged ≥65 years, who attended the ED at least eight times in the twelve month period were included. Data analysis compared the index ED visit and last ED visit in financial year 2016-17.
Results: There were 1387 ED visits by 115 patients. The median ED visits was 11 (interquartile range=9-13). There was no significant change in community health, home or residential care services use from the index ED attendance compared to the last ED attendance (54.8% vs 61.4% p=0.185). The median age-adjusted Charlson comorbidity score increased significantly and was 5 [IQR=4-6] at index and 6 [IQR=4-8] at last ED attendance (p<0.001). Most patients arrived by ambulance (67.0%, vs 73.0%, p=0.311) and almost half of the patients were triaged Australasian Triage Score category 3 (48.7% vs 44.3%, p=0.583) at either ED presentation.  Hospital admission occurred for three-quarters of patients at both visits (73.9% vs 76.5%, p=0.743). ED re-attendance within 28 days decreased from index to last ED attendances (58.1% vs 20.0%, p=<0.001). Hospital readmission within 30 days also decreased significantly (39.0% vs 22.8%, p=0.016). At the end of the study period, in-patient mortality was 11.3% (n=10/88).
Conclusion: Unavoidable frequent attendance to ED, with ensuing hospital admission, occurs for a group of older patients. Review of health service access to ED and hospital admission should be considered for these patients.

Debra Berry is an experienced emergency nursing clinician, educator and researcher. She is currently a Research Fellow in Deakin University’s   Centre for Quality and Patient Safety Research – Eastern Heath Partnership. In this joint appointment, Debra is leading and managing a number of studies related to patient safety and emergency care. Debra’s particular interests are; emergency department care of older people; health services provision and care delivery; and recognition and response to clinical deterioration.