However, redirecting care from the ED, or providing fast tracks for specific patient groups might also influence necessary visits and quality of care. It is suggested that the visits by FVs may be unnecessary improving patient education and developing safety netting pathways might help to reduce these visits. In addition, visiting a familiar doctor might improve patient satisfaction and patient outcomes. Therefore, preventing repeated visits by FVs or channeling FVs to another healthcare path might also reduce total health care costs. It was found that 31% of the cost of all pediatric ED patients was made by the FVs consisting of only 8% of the patients. In the Netherlands, visiting an ED is 2.5 times as expensive as visiting a pediatrician and almost 8 times as expensive as visiting the GP. Īpart from ED overload, visiting the ED is an expensive form of receiving care. The high number of visits made by FVs may partially contribute to ED crowding. Therefore, a small group of patients accounts for a large number of visits, making them frequent visitors (FV). Of all ED visitors, a subgroup of patients frequently seeks medical attention at the ED. In the Netherlands, the ED visiting rate is reported to be 115 visits per 1000 inhabitants with 1 out of 5 below 18 years old or younger. Patients can either visit the ED at their own initiative (self-referral) by out of hospital emergency services or referred by a previous (emergent) health care contact from either primary or secondary care. The emergency department (ED) is an important location where patients of all ages receive acute medical care. If these data are used for other research questions, users are requested to notify the senior author ( or by contacting PlosOne.įunding: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: A minimum anonymized database to reproduce the analyses is available through the supporting information file 6. Received: JAccepted: DecemPublished: January 27, 2022Ĭopyright: © 2022 Vrijlandt et al. PLoS ONE 17(1):Įditor: Biswadev Mitra, Monash University School of Public Health and Preventive Medicine, AUSTRALIA We identified the presence of a comorbidity (non-complex CD HR 1.66 1.52–1.81 and complex CD HR 2.00 1.84–2.16) as determinants with the highest hazard for a return visit.Ĭitation: Vrijlandt SEW, Nieboer D, Zachariasse JM, Oostenbrink R (2022) Characteristics of pediatric emergency department frequent visitors and their risk of a return visit: A large observational study using electronic health record data. Overall, FVs presented at the ED more often because of an infection (41.3%) compared to non-FVs (27.4%), either associated or not with the body system affected by the CD. At visit-level, frequent visits were more often initiated by self-referral and were more often related to medical problems (compared to trauma’s). At patient-level, FVs were younger and more often suffered from chronic diseases (CDs). Our study population of 10,209 children with 16,397 ED visits contained 500 FVs (4.9%) accounting for 3,481 visits (21.2%). ![]() Risk factors for a recurrent ED visit were determined using a Prentice Williams and Peterson gap time cox-based model. ![]() Descriptive analysis of the study cohort at patient- and visit-level were performed. Children with 4 or more ED visits within 365 days were classified as FVs. Data of all children aged 0–18 years visiting the ED of a university hospital in the Netherlands between 20 were included in this observational study based on routine data extraction.
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