What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis.

Patients who frequently attend to emergency departments are a varying group and have complex health care needs. This systematic review and meta-analysis aimed to determine the prevalence of patients who have frequent attendance to emergency departments. A systematic review was performed in line with PRISMA guidelines. A database search was conducted, and studies were included in the final review if they analysed a population of frequent attendance. Meta-analysis was performed only on population-based studies to estimate prevalence. The search yielded 2922 nonduplicate publications, of which 27 were included in the meta-analysis. The most common definition used for frequent attendance was greater than three presentations a year. The proportion of people who frequently attended as a percentage of the total study population ranged from 0.01 to 20.9%, with emergency department presentations from frequent attenders ranging from 0.2 to 34%. When limiting the definition of frequent attendance to greater than three visits in a 12-month period, people who frequently attended contributed between 3 and 10% [pooled estimate 6%; CI 4-7%] of emergency department presentations and between 12 and 34% [pooled estimate 21%; CI 15-27%] of total emergency department presentations. Meta-analysis found substantial heterogeneity between estimates [I2 > 50%]. The prevalence of frequent attendance compared to the total population of patients seeking emergency care was small, but the impact on emergency department utilisation is significant. Early identification of people attending for frequent care at an emergency department provides the opportunity to implement alternative models of care.