High-Frequency Users of an Urban Emergency Department – Comparison of demographic, clinical, and cost characteristics of homeless and non-homeless frequent-users of an urban Emergency Department

Objective: High levels of utilization by groups seeking care for non-urgent conditions has placed an increasing strain on Emergency Departments (EDs). Little is known about utilization and costs associated with one such group – the urban homeless. This study describes a cohort who were frequent visitors to an ED in an urban tertiary-care hospital. Methods: Records for patients who made more than 5 visits to a single ED over a single year (2006) were retrospectively reviewed. Demographic and clinical characteristics including homeless status were recorded for each visit from these chart reviews. Cost data were obtained from billing and payment records. Results: 529 frequent users made 5,360 visits to the ED during the study period, representing more than one-fifth of total visits. 74 frequent users (14.0%) were homeless. Substance use was diagnosed more frequently in the homeless (14.3% vs. 2.8%). No homeless visitors had private insurance, and 25.7% were uninsured. One-fifth of homeless visitors presented with a non-urgent complaint. The top 10 users each had annual costs exceeding $10,000, while the most frequent user alone had costs of nearly $100,000. Conclusions: Reviewing frequent visitors' use of the ED offers important insights. Homeless individuals make up a large portion of these users. They commonly present for substance use and non-urgent issues. Developing interventions to provide the homeless with alternatives to seeking care in the ED for these conditions will likely reduce costs while improving outcomes.