Investigation of recurrent applications to emergency departments

AIM: The aim of this study was to investigate the data of the patients who applied to Gaziantep University Medical Faculty Hospital Emergency Department between January 1, 2007 and December 31, 2017 and to determine the rate of referral and the rate of patients using the emergency department. In this way, it will be possible to take measures towards the intensity of emergency services by evaluating the findings obtained at the end of the study. MATERIAL AND METHOD: This retrospective cross - sectional study was performed in the Emergency Department of Gaziantep University Medical Faculty Hospital between 01.01.2007-31.21.2017. Data of the patients were taken from Hospital Information Management System and recorded in excel file. The data were analyzed using the Statistical Package for Social Sciences-20 (SPSS-20) and the 4.7.0 version of the Joinpoint software. P <0.05 was considered statistically significant in all comparisons. Patients presenting to the emergency department with 4 or more applications within a period of 1 year were identified as frequent users. Patients with an annual 4 or more applications and 50% or more of these applications resulted in discharge were described as inappropriate users. RESULTS: Between 2007 and 2017, 1.266.535 patients were admitted to our emergency department. Of these, 52.22% were female and 47.78 were male. Female patients applied more frequently in the last 11 years than male patients and this rate was found to be statistically significant. The rate of increase in the number of applications was 22% per annum. The rate of increase in male and female patients was 22% and 23%, respectively. 12.5% of the patients were defined as frequent users, and these patients accounted for 38% of all applications. Patients using the emergency department were 9.8% of all patients and accounted for 30% of all applications. Patients with comorbidities used the emergency department less frequently (11%), and these patients were less abused by the emergency department (8%). These rates were statistically significant when compared with all patients. DISCUSSION AND CONCLUSIONS: Turkey continues to increase in intensity in the emergency department. There are several reasons for this intensity. Patients who are frequently referred to the emergency department are responsible for a significant portion of the intensity of emergency services. In this group of patients, the rate of inappropriate use of the emergency department is very high. We recommend policy makers and health care providers to take into account the number of patients who frequently apply when creating a solution for the intensity of emergency services. In the literature, there are some solutions for this patient group. The first solution is patient training on the appropriate use of health services to help them make more rational decisions. The second recommendation is to rearrange the health system by increasing the continuity of care outside regular working hours. The third recommendation is to direct the patients to the emergency department through the referral chain from the first level polyclinics. Finally, it is to establish first-line polyclinic structures near the recommended emergency services. In this way, patients can have access to first-line outpatient clinics after an emergency service triage. Additional recommendations include the development of hospital policies such as increasing the number of physicians, shortening the length of stay of patients, and increasing the number of auxiliary medical staff. KEY WORDS: Emergency deparment, frequent users, Inappropriate use