Characteristics of Frequent Users of Emergency Medical Services in Singapore. (4th March 2019)

• Record Type: Journal Article
• Authors: Kuek, Benjamin J.W.; Li, Huihua; Yap, Susan; Ng, Marie X.R.; Ng, Yih Yng; White, Alexander E.; Ong, Marcus E.H.
• Is Part Of: Prehospital emergency care. Volume 23:Number 2(2019)
• Page Start: 215
• Page End: 224
• Publication Date: 2019-03-04
• Subjects: frequent caller -- ambulance -- healthcare resources; 362.18
• DOI: 10.1080/10903127.2018.1484969
• Languages: English
• ISSNs: 1090-3127

Abstract

Abstract: Objectives: This study aims to describe frequent users of Emergency Medical Services (EMS) conveyed to a Singapore tertiary hospital, focusing on a comparison between younger users (age <65) and older users in diagnoses and admission rates.Methods: All patients conveyed by EMS to a tertiary hospital 4 times or more over a 1-year period in 2015 had their EMS ambulance charts and Emergency Department (ED) electronic records retrospectively analyzed ( n = 243), with admission the primary outcome.Results: The 243 frequent users were analyzed with a combined total of 1, 705 visits, out of a total of 10, 183 patients with 12, 839 visits conveyed by EMS to Singapore General Hospital (SGH) in 2015. Younger frequent users (<65 years age) were found to be predominantly male (79.6%, p = 0.001) and were on average responsible for more visits than elderly frequent users (8.6 vs. 5.7, p = 0.004). Medical co-morbidities were significantly more prevalent in older users. Younger frequent users were more likely to be smokers (60.2% vs. 22.3%), heavy drinkers (51.3% vs. 8.5%), substance abusers (12.4% vs. 0.8%), and bad debtors (49.6% vs. 20.0%, p < 0.001). A larger proportion presented with altered mental states (11.7% vs. 5.4%, p < 0.001) and alcohol related diagnoses (34.7% vs. 5.3%, p < 0.001). Many were picked up from public areas (45.5% vs. 19.6%, p < 0.001), and had lower acuity triage scores at both EMS (p < 0.001) and ED (p = 0.001). They had lower admission rates (40.5% vs. 78.7%, p < 0.001) and shorter length of stay (4.3 vs. 5.9 days, p < 0.001). Univariable and multivariable analysis showed alcohol related diagnoses, history of alcohol abuse and lower triage scores were less likely to require admissions.Conclusion: Frequent EMS users consume a disproportionate amount of healthcare resources. Two broad subgroups of patients were identified: younger patients with social issues and older patients with multiple medical conditions. EMS usage by older patients was significantly associated with higher rates of admission