The chronic emergency department patient

The chronic emergency department visitor presents a common but largely unstudied problem. Using the criterion of one or more visits per month for a six-month period, a population of 16 frequent or chronic visitors was identified at our institution. These chronic visitors were predominantly single (94%), men (81%), with an average age of 48.5 years. Alcoholism was present in 87.5% and 56% were suffering from a chronic psychiatric condition. The majority were dependent on government support (75%) and lived alone (69%). Ambulance transport was used for 84% of the visits, but in only 6% of the visits was hospital admission required. We concluded that these patients became the responsibility of the ED by default because alcoholism or mental illness prevented their compliance with any therapeutic program. Furthermore, this group is at high risk for medical and traumatic illness, and the physician must not let familiarity lead to careless evaluation. Several suggestions for disposition are provided, for the diversion of one such patient to an alternate and more appropriate source of care creates enormous savings in medical time and expense.