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01.12.2014 | Original Research | Ausgabe 1/2014 Open Access

International Journal of Emergency Medicine 1/2014

Rate, characteristics, and factors associated with high emergency department utilization

International Journal of Emergency Medicine > Ausgabe 1/2014
M Christien van der Linden, Crispijn L van den Brand, Naomi van der Linden, Anna HJH Rambach, Caro Brumsen
Wichtige Hinweise

Competing interests

The authors declare that there are no competing interests.

Authors’ contributions

CvdL had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept & design: CvdL, CvdB, NvdL, AR, and CB. Acquisition of the data: CvdL. Analysis and interpretation of data: CvdL and CvdB. Drafting of the manuscript: CvdL, CvdB, NvdL, and AR. Critical revision of the manuscript for important intellectual content: CvdB and CB. All authors read and approved the final manuscript.



Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent visitors (FV) and highly frequent visitors (HFV) is necessary in order to plan more effective interventions.
In the Netherlands, the incidence of high ED utilization is unknown. The purpose of this study was to investigate if the well-documented international high ED utilization also exists in the Netherlands and if so, to characterize these patients. Therefore, we assessed the proportion of FV and HFV; compared age, sex, and visit outcomes between patients with high ED utilization and patients with single ED visits; and explored the factors associated with high ED utilization.


A 1-year retrospective descriptive correlational study was performed in two Dutch EDs, using thresholds of 7 to 17 visits for frequent ED use, and greater than or equal to 18 visits for highly frequent ED use.


FV and HFV (together accounting for 0.5% of total ED patients) attended the ED 2,338 times (3.3% of the total number of ED visits). FV and HFV were equally likely to be male or female, were less likely to be self-referred, and they suffered from urgent complaints more often compared to patients with single visits. FV were significantly older than patients with single visits and more often admitted than patients with single visits. Several chief complaints were indicative for frequent and highly frequent ED use, such as shortness of breath and a psychiatric disorder.


Based on this study, high ED utilization in the Netherlands seems to be less a problem than outlined in international literature. No major differences were found between FV and HFV, they presented with the same, often serious, problems. Our study supports the notion that most patients with high ED utilization visit the ED for significant medical problems.
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