Two-year retrospective analysis of repeated emergency service admissions in a secondary stage hospital: Diagnosis-based evaluation

Year 2025, EARLY ONLINE, 1 - 8

Semih Eriten

https://doi.org/10.18621/eurj.1617981

Abstract

Objective: This study aims to evaluate the characteristics of repeated emergency department (ED) visits in a secondary care hospital over a two-year period and analyze trends across different diagnostic categories.

Methods: A retrospective analysis was conducted on ED visit data from January 2023 to September 2024. Patient demographics, primary diagnoses, and visit frequencies were examined. Statistical analyses were performed to compare trends between 2023 and 2024, with subgroup analyses based on age and gender.

Results: The repeated visit rate was found to be 25.8% in 2023 and 26.0% in 2024, consistent with existing literature. The most common diagnosis was upper respiratory tract infections (URTI), accounting for 109,067 visits in 2023 and 83,655 visits in 2024, showing a significant decline. In contrast, general medical examinations and gastroenteritis cases increased in 2024 compared to 2023, indicating a potential shift in healthcare-seeking behavior. Myalgia ranked second, with 26,727 cases in 2023 and 21,225 in 2024, predominantly affecting middle-aged women. Falls and soft tissue disorders, ranked third, were more prevalent in male patients, with 24,351 cases in 2023 and 19,616 in 2024. Age-specific trends showed that trauma-related conditions were most common in children (0-10 years), while musculoskeletal and cardiovascular disorders increased with age. Gender distribution analysis indicated that headache and acute cystitis were more frequent in women, whereas falls and cardiovascular diseases were more common in men.

Conclusions: The findings highlight the need for better coordination between emergency and primary healthcare services to reduce unnecessary repeat visits. The shift in diagnostic trends suggests that regional healthcare planning should adapt to evolving patient needs. Future research should explore psychosocial factors contributing to repeat visits and assess the economic burden of ED overutilization.

Keywords

Emergency department, duplicate visit, diagnosis analysis, retrospective study, second-level hospital

Ethical Statement

This retrospective cross-sectional study was conducted in a secondary health care state hospital. The study was approved by the Ethics Committee of Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital (Decision No: 305, Date: 06.11.2024). The study was conducted in accordance with the principles of the Declaration of Helsinki.

References

• 1. Ahn BK, Cho S, Kim S, Lee TJ, Park J. Identifying characteristics of frequent and highly frequent users of the emergency department: A retrospective cross-sectional observational study. J Korean Soc Emerg Med. 2021;32(3):263-272. doi: 10.0000/jksem.2021.32.3.263.
• 2. Budnitz DS, Shehab N, Lovegrove MC, Geller AI, Lind JN, Pollock DA. US Emergency Department Visits Attributed to Medication Harms, 2017-2019. JAMA. 2021;326(13):1299-1309. doi: 10.1001/jama.2021.13844.
• 3. Burton C, Stone T, Oliver P, Dickson JM, Lewis J, Mason SM. Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data. Emerg Med J. 2022;39(1):3-9. doi: 10.1136/emermed-2020-210772.
• 4. Chastonay OJ, Lemoine M, Grazioli VS, et al. Health care providers' perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland. BMC Emerg Med. 2021;21(1):4. doi: 10.1186/s12873-020-00397-w.
• 5. Chiu Y, Racine-Hemmings F, Dufour I, et al. Statistical tools used for analyses of frequent users of emergency department: a scoping review. BMJ Open. 2019;9(5):e027750. doi: 10.1136/bmjopen-2018-027750.
• 6. Cho ED, Kim B, Kim DH, Lee SG, Jang SY, Kim TH. Factors related to the frequent use of emergency department services in Korea. BMC Emerg Med. 2023;23(1):73. doi: 10.1186/s12873-023-00808-8.
• 7. Cordell B, Nguyen K, Shahir AK, Lord SJ, Gallego G. Prevalence and characteristics of frequent presenters to Auburn Hospital emergency department. Emerg Med Australasia. 2022;34(6):898-906. doi: 10.1111/1742-6723.14011.
• 8. Çıkrıkçı Işık G, Tandoğan M, Şafak T. Çevik Y. Retrospective Analyses of Frequent Emergency Department Users. Eurasian J Emerg Med. 2020;19(2):89-93. doi: 10.4274/eajem.galenos.2019.07108
• 9. de Groot B, Meijs NTC, Moscova M, et al. Characteristics and outcomes of emergency department patients across health care systems: an international multicenter cohort study. Int J Emerg Med. 2024;17(1):123. doi: 10.1186/s12245-024-00715-0.
• 10. Doan Q, Barbic D. Are mood disorders associated with frequent emergency department visits? Question answered, or a dialogue just beginning? CJEM. 2022;24(1):3-4. doi: 10.1007/s43678-021-00238-0.
• 11. Fleury MJ, Cao Z, Grenier G, Huỳnh C. Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. Int J Environ Res Public Health. 2022;19(11):6607. doi: 10.3390/ijerph19116607.
• 12. Giannouchos TV, Kum HC, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review. J Eval Clin Pract. 2019;25(3):420-433. doi: 10.1111/jep.13137.
• 13. Hughes JA, Douglas C, Jones L, et al. Identifying patients presenting in pain to the adult emergency department: A binary classification task and description of prevalence. Int Emerg Nurs. 2023;68:101272. doi:10.1016/j.ienj.2023.101272
• 14. Kanzaria HK, Niedzwiecki M, Cawley CL, et al. Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses the Whole Person. Health Aff (Millwood). 2019;38(11):1866-1875. doi: 10.1377/hlthaff.2019.00082.
• 15. Kim SH, Lee H. Characteristics of consecutive versus non-consecutive frequent emergency medical services transport to a single emergency department. PLoS One. 2024;19(5):e0301337. doi: 10.1371/journal.pone.0301337.
• 16. Kuan WS, Chua MT. Frequent attenders to multiple emergency departments in Singapore. Ann Acad Med Singap. 2022;51(8):460-461. doi: 10.47102/annals-acadmedsg.2022216.
• 17. Laferté C, Dépelteau A, Hudon C. Injuries and frequent use of emergency department services: a systematic review. BMJ Open. 2020;10(12):e040272. doi: 10.1136/bmjopen-2020-040272.
• 18. Lee JH, Park GJ, Kim SC, Kim H, Lee SW. Characteristics of frequent adult emergency department users: A Korean tertiary hospital observational study. Medicine (Baltimore). 2020 May;99(18):e20123. doi: 10.1097/MD.0000000000020123.
• 19. Moe J, O'Sullivan F, McGregor MJ, et al. Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis. CMAJ Open. 2021;9(1):E134-E141. doi: 10.9778/cmajo.20200168.
• 20. Moe J, Wang EY, McGregor MJ, et al. People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study. CMAJ Open. 2022;10(1):E220-E231. doi: 10.9778/cmajo.20210131.
• 21. Osawa I, Sato T, Goto T, Sonoo T, Iwai S, Nakajima S. Characteristics and subgroups of frequent emergency department users in an academic hospital in Japan. Acute Med Surg. 2020;7(1):e535. doi: 10.1002/ams2.535.
• 22. Pearce S, Marchand T, Shannon T, Ganshorn H, Lang E. Emergency department crowding: an overview of reviews describing measures causes, and harms. Intern Emerg Med. 2023;18(4):1137-1158. doi: 10.1007/s11739-023-03239-2.
• 23. Soril LJJ, Leggett LE, Lorenzetti DL, Noseworthy TW, Clement FM. Characteristics of frequent users of the emergency department in the general adult population: A systematic review of international healthcare systems. Health Policy. 2016;120(5):452-461. doi: 10.1016/j.healthpol.2016.02.006
• 24. Sultanoğlu H, Gamsızkan Z, Cangür Ş. [Investigation and Solution Proposals of Repeating Applications in Patients Admitted to the Emergency in a Year]. Düzce Univ Sağlık Bil Enst Derg. 2021;11(1):50-55. doi: 10.33631/duzcesbed.751317. [Article in Turkish]
• 25. Tuller D. A New Way to Support Frequent Emergency Department Visitors. Health Aff (Millwood). 2022;41(7):934-938. doi: 10.1377/hlthaff.2022.00680.
• 26. von Allmen M, Grazioli VS, Kasztura M, et al. Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception. BMC Emerg Med. 2021;21(1):92. doi: 10.1186/s12873-021-00481-9.
• 27. Norman C, Mello M, Choi B. Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses. West J Emerg Med. 2016;17(1):39-45. doi: 10.5811/westjem.2015.10.28508.