I Have Seen You Before - Frequent Users of the Pediatric Emergency Room

Background: Patients’ overuse of emergency room (ER) services is a serious and growing health care problem in Portugal. Particularly in pediatric age, there is often misuse of resources with overburden of the ER with non-urgent conditions. Recurring visits are also a major concern.

Objective: Characterize the most recurring patients of a pediatric ER service.

Methods: Descriptive study, conducted in a suburban hospital in Portugal. Sample consisting of the 20 most frequent users of the pediatric ER per year, in the last 3 years. Data regarding to patient’s visits to the ER, medical history and socioeconomic status were collected from their clinical file. Software Microsoft Excel was used for statistical analysis.

Results: 60 patients, 26 female, with median age at the first ER visit of 11 months (IQR 2,04)[4 days-16 years old] and an average of 20 visits each per year (SD 5,97)[15-49]. Almost all continued to be and/or were frequent users of the ER in the previous years, with multiple recurrences during the same acute episode (48 out of 60), sometimes more than once per day (31 out of 60). A significant number of romanies was registered. Almost half the sample didn’t have chronic diseases and among the ones that had, 22 of the 31 had recurrent wheezing/asthma. Although 41 of the 60 attended hospital consultations, 16 of them often missed the appointments. A similar behavior was noted regarding primary care follow-up (15 out of 60). There was a high prevalence (34 out of 60) of patients coming from low income families.

Conclusion: Healthcare education programs, especially for at-risk populations, alongside with optimized links between primary and secondary care are needed. Particularly in chronic patients, better management of the disease with empowerment of the patient/caregiver and easier access to ambulatory revaluation should also help reduce ER overflow.