It is important to identify such patients, as they account for up to 30% of the ED’s visit workload. Urban studies using the definition of 4 or more visits consistently characterize the high-frequency ED population as less than 10% (typically 3% to 6%) of their total ED visitor populations. A more manageable standard would identify the top 10% or less of ED patients who visit most frequently. Applying a high-frequency definition that works well in urban centres is a poor fit for a rural hospital ED when analyzing visit and service patterns.Ī definition of high-frequency ED use (≥ 4 visits) that identifies 16.7% of the population as high-frequency users is intuitively overinclusive. In an urban context, patients have access to after-hours primary care and urgent-care centres. The context of the ED in a rural setting is important.

Such context and complement differences affect use and seem to increase it. The rural ED is an after-hours extension of primary care services. Patients with simple sprains and lacerations must seek ED treatment, where urban environments have alternative services for after-hours and weekend care for such concerns.

There is typically no discrete set of emergency service providers, nor alternate treatment services available, and after-hours primary or urgent care is limited, by default, to the local ED. The context also differs in a rural setting. Similarly, patients know who is on shift and might choose an elective visit to the ED to see their family doctors. They might, for convenience, have some patients “schedule” a visit when they are on shift in the ED. In a rural setting the same group of general practitioners who provide primary care during office hours also attend the ED after hours. Rural ED environments differ from urban centres in both context and complement. 7 Although these figures do not account for the influx of summer-only populations to this area, it does highlight a heavier reliance on rural EDs. 6 Rural figures differ: in an emergency-use analysis of 5 rural Huron County EDs in 2000, the rate of use was 89 per 100 population. 5 Ten years later, it had increased to 42 per 100 population. In 1997 in Ontario, the number of ED visits per capita was 33 per 100 population. In this study, we will examine common definitions in the literature, see how they might apply in one rural ED in northwestern Ontario, and suggest a rural standard.Rural service environments are unique 4 Agreeing on a broadly applicable definition of high-frequency use is important. Despite the regularity of discussing high-frequency ED users, there is no consistent definition. 1– 3 Certainly, front-line ED physicians and nurses are very familiar with these patients. Analyses of emergency department (ED) use have always acknowledged patients who use the service more often than the norm.

Ed visits lane disease definition