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{
    "pk": 11849,
    "title": "Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department",
    "subtitle": null,
    "abstract": "Introduction:\n Highly frequent users (HFU) of the emergency department (ED) are a poorly defined population. This study describes patient and visit characteristics for Canadian ED HFU and patient subgroups with mental illness, substance misuse, or ≥ 30 yearly ED visits.\nMethods:\n We reviewed health records from a random selection of adult patients whose visit frequency comprised the 99th percentile of yearly ED visits to The Ottawa Hospital. We excluded scheduled repeat ED assessments. We collected the following: 1) patient characteristics – age, sex, and comorbidities; and 2) ED visit characteristics – diagnosis category, length of stay, presentation time, consultation services, and final disposition. Two reviewers collected data, and we performed an inter-rater review to measure agreement. \nResults: \nWe analyzed 3,164 ED visits for 261 patients in all subgroups overall. Within the HFU random selection, mean age was 53.4 ± 1.3, and 55.6% were female. Most patients had a fixed address (88.9%), and family physician (87.2%). Top ED diagnoses included musculoskeletal pain (9.6%), alcohol intoxication (8.5%), and abdominal pain (8.4%). Allied health (social work, geriatric emergency medicine, or community care access centre) was consulted for 5.9% of visits. In 52.7% of these cases, allied health services were not available at the time of presentation. \nConclusion:\n HFU are a complex population who represent a marked proportion of annual ED visits. Our data indicate that there are opportunities to improve the current approaches to care. Future work examining ED-based screening and multi-disciplinary approaches for HFU may help reduce frequent ED presentations, and better serve this vulnerable population.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "emergency department"
        },
        {
            "word": "Frequent Users"
        }
    ],
    "section": "Resource Utilization",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0bn6254n",
    "frozenauthors": [
        {
            "first_name": "Julie",
            "middle_name": "J.",
            "last_name": "Kim",
            "name_suffix": "",
            "institution": "University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada",
            "department": "None"
        },
        {
            "first_name": "Edmund",
            "middle_name": "S.H.",
            "last_name": "Kwok",
            "name_suffix": "",
            "institution": "University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada\nOttawa Hospital Research Institute, Ottawa, Ontario, Canada",
            "department": "None"
        },
        {
            "first_name": "Olivia",
            "middle_name": "G.",
            "last_name": "Cook",
            "name_suffix": "",
            "institution": "University of Ottawa, Department of Undergraduate Medicine, Ottawa, Ontario, Canada",
            "department": "None"
        },
        {
            "first_name": "Lisa",
            "middle_name": "A.",
            "last_name": "Calder",
            "name_suffix": "",
            "institution": "University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada\nOttawa Hospital Research Institute, Ottawa, Ontario, Canada",
            "department": "None"
        }
    ],
    "date_submitted": "2018-06-15T17:09:21Z",
    "date_accepted": "2018-06-15T17:09:21Z",
    "date_published": "2018-10-18T19:17:06Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11849/galley/6344/download/"
        }
    ]
}