EVALUATION OF THE FREQUENT APPLICATIONS TO AN UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT: A 1-YEAR REVIEW

Yıl 2023, , 372 - 380, 26.12.2023

Ogün Küpçük , Özgür Tatlı , Vildan Özer , Perihan Şimşek , Abdulkadir Gündüz

https://doi.org/10.24938/kutfd.1160817

Öz

Objective: Frequent use of emergency departments is an important problem that leads to decreased service quality and increased health costs in these departments. In the present study, the purpose was to analyze the demographic and clinical characteristics of “frequent users’ in applications to emergency departments.
Material and Methods: In the study, the records of patients, who were aged 18 years and older and who applied to the emergency department of a university hospital in 2016, were analyzed retrospectively. Those who applied to the emergency department between 4 and 9 times were defined as “Low ED Users’, and those who applied for 10 or more were defined as “High ED Users’.
Results: In 1 year, a total of 86.287 applications were made to the emergency department by 54.258 patients, during which 5.26% (n=2859) of those who applied to the emergency department applied 4-9 times (Low ED Users) and 0.29% (n=162) applied 10 or more times (High ED Users). Applications made by frequent users (n=16.277) constituted 18.8% of all applications in a year. The most common reason for frequent users’ admission was upper respiratory tract infections and 44.3% of the frequent user referrals were young patients who were under the age of 30. It was found that the patients in the High ED Users group underwent more examination and treatment than the Low ED Users group, and the hospitalization rates were higher in the High ED Users group (p<0.001).
Conclusion: “Frequent applications” are made more by young individuals who are under the age of 30 and consist of health problems that do not require emergency care in general. This especially increases the need for medical resources.

Anahtar Kelimeler

Emergency medicine, frequent admission, frequent users

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Bir Üniversite Hastanesi Acil Servisine Yapılan Sık Başvuruların Değerlendirilmesi: Bir Yıllık İnceleme

Öz

Amaç: Sık kullanım, acil servislerde hizmet kalitesinin düşmesine ve sağlık giderlerinin artmasına yol açan önemli bir sorundur. Çalışmada, acil servislere yapılan başvurularda ‘sık kullanıcıların’ demografik ve klinik özelliklerinin analiz edilmesi hedeflendi.
Gereç ve Yöntemler: Çalışmada bir üniversite hastanesi acil servisine, 2016 yılı içerisinde 18 yaş ve üzerindeki hastalar tarafından yapılan başvurulara ait kayıtlar retrospektif olarak incelendi. Sık kullanıcılardan, 4-9 arasında acil servis başvurusu yapanlar “Acil Servisi Az Kullananlar”, 10 ve daha fazla sayıda başvuru yapanlar ise “Acil Servisi Çok Kullananlar” olarak nitelendirildi.
Bulgular: Bir yıllık dönemde acil servise 54.258 hasta tarafından 86.287 başvuru yapıldı. Bu dönemde acil servise başvuranların %5.26’sı (n=2.859) 4-9 kez (Acil Servisi Az Kullananlar), %0.29’u (n=162) ise 10 ve daha fazla kez (Acil Servisi Çok Kullananlar) başvurdu. Sık kullanıcıların yaptığı başvurular (n=16.277), bir yıl içinde yapılan tüm başvuruların
%18.8’ini oluşturuyordu. Sık kullanıcıların en sık başvuru nedeni üst solunum yolu enfeksiyonları idi. Sık kullanıcı başvurularının %44.3’ü 30 yaş altı genç hastalardı. “Acil Servisi Çok Kullananlar” grubundaki hastalara “Acil Servisi Az Kullananlar” grubuna oranla daha fazla tetkik ve tedavi işlemi uygulandığı ve hastaneye yatış oranlarının “Acil Servisi Çok Kullananlar” grubunda daha yüksek olduğu belirlendi (p<0.001).
Sonuç: Sık başvurular özellikle 30 yaş altı genç bireyler tarafından daha fazla yapılmaktadır. Acil servislere yapılan ‘sık başvurular’ genel anlamda acil bakım gerektirmeyen sağlık sorunlarından oluşmaktadır. Bu durum özellikle tıbbi kaynak ihtiyacını da arttırmaktadır.

Anahtar Kelimeler

Acil Tıp, sık başvuru, sık başvuranlar

Proje Numarası

-

Kaynakça

• Moore BJ, Liang L. Costs of emergency department visits in the united states, 2017. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); December 8, 2020.
• Parkinson B, Meacock R, Checkland K, Sutton M. Clarifying the concept of avoidable emergency department attendance. Journal of Health Services Research & Policy. 2021;26(1):68-73.
• Beştemir A, Aydın H. Yıllık 300 milyon hasta muayenesi; Türkiye’de 2. ve 3. basamak kamu sağlik tesisleri acil servis ve poliklinik hizmetlerinin değerlendirilmesi. Sakarya Tıp Dergisi. 2022;12(3):496-502.
• Chan JS-E, Tin AS, Chow WL, Tiah L, Tiru M, Lee CE. Frequent attenders at the emergency department: An analysis of characteristics and utilisation trends. Proceedings of Singapore Healthcare. 2017;27(1):12-9.
• Lucas RH, Sanford SM. An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med. 1998;32(5):563-8.
• Althaus F, Stucki S, Guyot S, Trueb L, Moschetti K, Daeppen JB, et al. Characteristics of highly frequent users of a Swiss academic emergency department: A retrospective consecutive case series. Eur J Emerg Med. 2013;20(6):413-41.
• Krieg C, Hudon C, Chouinard MC, Dufour I. Individual predictors of frequent emergency department use: A scoping review. BMC Health Services Research. 2016;16(1):594.
• Karadeniz Teknik Üniversitesi Farabi Hastanesi, Genel Uyum Rehberi [online]. [son güncelleme 26 Şubat 2021, 8 Nisan 2023 tarihinde erişildi] URL: https://www.ktu.edu.tr/dosyalar/farabikalite_c2954. pdf.
• LaCalle E, Rabin E. Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of Emergency Medicine. 2010;56(1):42-8.
• Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: A state wide analysis. Ann Emerg Med. 2006;48(1):9-16.
• Hardie TL, Polek C, Wheeler E, McCamant K, Dixson M, Gailey R, et al. Characterising emergency department high-frequency users in a rural hospital. Emerg Med J. 2015;32(1):21-5.
• Boh C, Li H, Finkelstein E, Haaland B, Xin X, Yap S, et al. Factors contributing to inappropriate visits of frequent attenders and their economic effects at an emergency department in singapore. Academic Emergency Medicine. 2015;22(9):1025-33.
• Soril LJ, Leggett LE, Lorenzetti DL, Noseworthy TW, Clement FM. Reducing frequent visits to the emergency department: A systematic review of interventions. PloSone. 2015;10(4):e0123660.
• Milbrett P, Halm M. Characteristics and predictors of frequent utilization of emergency departments. J Emerg Nurs. 2009;35(3):191-8.
• Moore L, Deehan A, Seed P, Jones R. Characteristics of frequent attenders in an emergency department: Analysis of 1-year attendance data. Emerg Med J. 2009;26(4):263-7.
• Hardy M, Cho A, Stavig A, Bratcher M, Dillard J, Greenblatt L, et al. Understanding frequent emergency department use among primary care patients. Population Health Management. 2018;21(1):24-31.
• LaCalle EJ, Rabin EJ, Genes NG. High-frequency users of emergency department care. The Journal of Emergency Medicine. 2013;44(6):1167-73.
• Murphy AW, Leonard C, Plunkett PK, Brazier H, Conroy R, Lynam F, et al. Characteristics of attenders and their attendances at an urban accident and emergency department over a oneyear period. Journal of Accident & Emergency Medicine. 1999;16(6):425-7.
• McCusker J, Healey E, Bellavance F, Connolly B. Predictors of repeat emergency visits by elders. Acad Emerg Med. 1997;4(6):581-8.
• Blank FS, Li H, Henneman PL, Smithline HA, Santoro JS, Provost D, et al. A descriptive study conducted by heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs. 2005;31(2):139-44.