Millions of patients visit hospital emergency departments (EDs) each year for a variety of injuries and ailments. A sizable minority of ED patients returns to the ED frequently and account for a disproportionately large share of overall visits and costs. High revisit rates also signal potentially significant clinical implications for the patients themselves, including unfinished treatments and progression of illness. In 2015, AHRQ concluded an ACTION II field-based research project, led by a team from Johns Hopkins University, to identify the factors that drive patients’ frequent ED use, as well as possible ways to better address patients’ needs through ED-based interventions.
Toward this end, the research team began by conducting an Environmental Scan of the literature designed to identify: (a) the specific vulnerabilities of patients at highest risk of frequent ED use; (b) the causes, dimensions, and effects of problems with existing ED discharge processes; and (c) promising interventions to address patient needs.
The team then developed a Screening Checklist that could be used to quickly and systematically identify patients who possess one or more of the vulnerabilities identified from the Scan, and pilot-tested this checklist in three hospital EDs. In a research brief titled Characteristics of Frequent Users of Three Hospital Emergency Departments, the team summarizes what was learned from this pilot test about the characteristics and associated risk factors of the actual patients in the study population and how they compared with expectations based on the Scan.