Introduction: Patients who repeatedly attend the Emergency Department (ED) often have a distinct
and complex vulnerability profile that includes poor somatic, psychological, and social indicators. This profile has an impact on the patients' well-being as well as on hospital costs. The objective of the study was to specify the characteristics of hyper users (HU) and explore the connection with ED care and hospital costs.
Methods: The study sample comprised all adult patients with 12 or more attendances at the ED of the
Lausanne University Hospital in 2009. The data were collected by retrospectively searching internal
databases to identify the patients concerned and then analysing the profiles of these patients.
Information gathered included demographic, somatic, psychological, at-risk behaviour, and social
indicators, and health system consumption including costs.
Results: In 2009, 23 patients (0.1%) attended 12 times or more (425 attendances, 0.8%). The average age was about 43 years, 60.9% were female, and 47.8% single. Of these 95.7% had basic insurance, 87.0% had a general practitioner, and 30.4% were under legal guardianship. The majority attended in the evening or at night (67.1%), and almost one quarter of these attendances resulted in inpatient treatment (24.0%). Most HU had attended the ED in previous years too (95.7% in 2008). The most prevalent diagnoses concerned 'mental disorders' (87.0%). About 30.4% of patients had attempted suicide (all were female patients). Other frequent diagnoses concerned 'trauma' (65.2%), and the 'digestive' and the 'nervous system' (each 56.5%). At-risk behaviour such as severe alcohol consumption (34.8%), or excessive use of medicines (26.1%) was very frequent, and some patients used illicit drugs (21.7%). There was only a weak association between the number of ED attendances and the resulting costs. However, a reduction of one outpatient visit per patient would have decreased ED outpatient costs by 8.5%.
Conclusions: HU often have a particularly vulnerable profile. Mental problems are prevalent among
them, as are at-risk behaviour and severe somatic conditions. The complexity of the patients' profiles
demands specific care that cannot be guaranteed within an everyday ED routine. The use of an
interdisciplinary case management team might be a promising approach in diminishing the number of attendances and the associated costs, although the profiles of HU are such that they probably cannot completely give up ED attendance.