Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes

Street, Maryann, Berry, Debra and Considine, Julie-Anne 2018, Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes, International journal for quality in health care, vol. 30, no. 8, pp. 624-629, doi: 10.1093/intqhc/mzy062.

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Title Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes
Author(s) Street, MaryannORCID iD for Street, Maryann
Berry, DebraORCID iD for Berry, Debra
Considine, Julie-AnneORCID iD for Considine, Julie-Anne
Journal name International journal for quality in health care
Volume number 30
Issue number 8
Start page 624
End page 629
Total pages 6
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2018-10
ISSN 1464-3677
Keyword(s) emergency department
frequent attenders
retrospective studies
science & technology
life sciences & biomedicine
health care sciences & services
health policy & services
Summary Objective: To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. Design: Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. Setting: Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. Participants: People aged ≥65 years attending the ED in financial year 2013/2014. Main Outcome Measures: The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. Results: Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. Conclusions: Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.
Language eng
DOI 10.1093/intqhc/mzy062
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Authors
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Document type: Journal Article
Collections: Faculty of Health
Centre for Quality and Patient Safety Research
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