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An observational pilot study: Prevalence and cost of high frequency emergency department users at Örebro University Hospital, Sweden
Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.ORCID iD: 0000-0001-7740-9558
Örebro University, School of Medical Sciences. Centre for Clinical Research Sörmland/Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden.ORCID iD: 0000-0002-6738-8615
Health and Medical Care Administration, Örebro County Council, Örebro, Sweden.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-3290-4111
2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 9, article id e0274622Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU.

METHODS: This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018-19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was ≥4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4-7, 8-18 and ≥19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU.

FINDINGS: Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen.

CONCLUSION: ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.

Place, publisher, year, edition, pages
PLOS , 2022. Vol. 17, no 9, article id e0274622
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
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URN: urn:nbn:se:oru:diva-101418DOI: 10.1371/journal.pone.0274622ISI: 000892087100092PubMedID: 36107928Scopus ID: 2-s2.0-85137925501OAI: oai:DiVA.org:oru-101418DiVA, id: diva2:1698391
Available from: 2022-09-23 Created: 2022-09-23 Last updated: 2024-01-16Bibliographically approved

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Cheng, IvyAndersson, JonasKurland, Lisa

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