Common Themes in Emergency Department Super-Utilization: A Retrospective Chart Review
Primary Investigator: Carson Hausmann, BSN, RN, DNP Candidate
Purpose: As emergency department (ED) use continues to rise locally and nationally, it is imperative that super-utilization be understood so that interventions can be tailored to conserve hospital resources. Using retrospective chart review, common themes in ED super-utilization were identified as a basis for planning interventions by nursing management at a local hospital.
Methods: This DNP Project examined demographics and common trends among ED super-utilizers using retrospective chart review. Characteristics of patients with two visits over a 6-month period (n=1367) were extracted and compared to the total population that utilized the ED during the same period (n= 41869). Odds ratios were computed to determine relative risk factors for ER super-utilization.
Results: The average super-utilizer was approximately 52 years of age, 2.3 times as likely to be classified as a behavioral health patient (P < 0.0001) and presented most often with chief complaints of abdominal pain/GI related, musculoskeletal/extremity pain, fever/flu-like symptoms, non-urgent, and GU/vaginal bleeding, with the notable difference being the increased incidence of fever and flu like symptoms when compared to the total ED population. These patients are generally classified as lower acuity than the average ED patient (3.06 and 2.97, respectively), 10 times as likely to be admitted to the hospital (P < 0.0001) and 3.4 times as likely to leave against medical advice (P < 0.0001).
Discussion: There were several parallels between the findings of previous research on super-utilization/recidivism and this DNP project, including the coexistence of behavioral health comorbidities, average age of super-utilizers and chief complaint frequency. However, differences were noted in average acuity level, admission rates and most common presenting complaints, with super-utilizers reporting select complaints at a higher frequency.
Conclusions: Utilizing the findings of this retrospective chart review, practice can be augmented to better care forecast those patients at higher risk for super-utilization. When a patient presents meeting several of these criteria, a query can be made to identify number of recent visits. This query could confirm the pattern of super-utilization and extra effort could be employed to arrange follow-up with an outpatient provider using case-management services and/or instruction on appropriate reasons for return to the ED.
Major Professor: Eileen Cormier, PhD
Keywords: super-utilization, emergency department, recidivism, retrospective chart review