A STUDY OF the 20 most common attendees of the Mater Hospital’s emergency department has found that most are men and all are unemployed.
The April edition of the Irish Medical Journal carries a retrospective review of those who attended the hospital’s ED most in 2014.
With hospital overcrowding a constant issue, the report says that there is little focus on frequent emergency department attendees.
However, a small number of patients are responsible for a disproportionate amount of ED visits with up to 4% of patients accounting for 18% of total ED visits in one particular study.
This group of patients often have psychosocial, substance misuse and/or chronic illness issues which play a factor in their repeat attendances.
The report says that community intervention in their care would be a more effective measure of treating those who attend regularly.
The review found that 85% of the top 20 (17) were men and 15% (3) were women.
The average age was 40.6 years old with a median age of 38.5. All were unemployed and medical card holders. Seven (35%) had no fixed abode and 13 (65%) lived within an average of 4.5 kilometres of the ED. Five of this 13 had recently been homeless and were living in temporary hostel accommodation.
Nineteen of the twenty most frequent presenters were single or separated from partners.
85% admitted to smoking, they had a significantly higher average attendance rate than non-smokers (84 v 36). Psychiatric conditions predominated with 65% having a previous mental health issue. One patient had bipolar affective disorder, one had obsessive compulsive disorder and one had schizophrenia.
Two had personality disorders, four had depression and four had co-existent depression and schizophrenia. The average number of attendances for those without a mental illness was 43.4 compared to 94.8 in those that did.
The presence of a mental illness was associated with a significantly higher attendance rate.
Only 30% denied misuse of alcohol with the majority being alcohol dependent (60%) or admitting to alcohol abuse (10%).
The average number of attendances for those misusing alcohol was 87 compared to 54 in those who did not. Misuse of alcohol was associated with significantly higher attendance rates.
Half of the patients had no drug related issues, with 15% having an opiate (heroin) addiction, 30% had a benzodiazepine addiction and one person had a polydrug addiction. Of those who misused drugs, their average attendance rate for 2014 was twice that of who did not misuse drugs (103 vs 51).
The authors of the study, Doctors Ramasubbu, Donnelly and Moughty say that there is no easy way to solve the issue of frequent attendees.
Ultimately, our very frequent attenders are a complex group of individuals who need a holistic approach to management. For many of our very frequent attenders this would involve addressing underlying causes such as drug and alcohol misuse, poorly managed mental health issues and social deprivation.
“Significant investment is required to improve services both inside and outside the hospital to relive the pressure felt from re-attenders in the emergency department.”
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