Frequent Emergency Department Use: A Social Emergency Medicine Perspective

Frequent emergency department (ED) use is of critical importance to policy makers, payers, and emergency providers. Frequent ED use can be a symbol of unmet medical needs, but research increasingly confirms that frequent ED users often have high unmet social needs related to housing, social support, food security, and end-of-life planning as well as disproportionate rates of behavioral health issues compared to non-frequent ED users. As a result, frequent ED users have higher morbidity and mortality compared to non-frequent ED users. While frequent ED users have been well-characterized in the peer-reviewed literature, research on interventions that may be effective in improving care and reducing ED use is generally of low quality. There is no current “off-the-shelf” intervention for frequent ED users, but case management appears to be the most promising solution. Integrated data systems that can capture ED visits at multiple EDs are essential to accurate identification of this population, yet it is also important to understand that frequent ED users often use other health and social care resources frequently. Thus, interventions should involve partners outside of the ED in both the health system and the community.