Cited by 251Emergency and Acute Care StudiesChronic Disease Management StrategiesHospital Admissions and Outcomes

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Reducing Frequent Visits to the Emergency Department: A Systematic Review of Interventions

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Soril, Lesley J. J., Leggett, Laura E., Lorenzetti, Diane L., Noseworthy, Tom W., Clement, Fiona M.·2015·PLOS ONE

DOI 10.1371/journal.pone.0123660PMC PMC4395429

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Abstract

OBJECTIVE: The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population. METHODS: Systematic review of the literature from 1950-January 2015. Studies were included if they: had a control group (controlled trials or comparative cohort studies), were set in an ED or acute care facility, and examined the impact of an intervention to reduce frequent ED use in a general adult population. Studies reporting non-original data or focused on a specific patient population were excluded. Study design, patient population, intervention, the frequency of ED visits, and costs of frequent ED use and/or interventions were extracted and narratively synthesized. RESULTS: Among 17 included articles, three intervention categories were identified: case management (n = 12), individualized care plans (n = 3), and information sharing (n = 2). Ten studies examining case management reported reductions in mean (-0.66 to -37) or median (-0.1 to -20) number of ED visits after 12-months; one study reported an increase in mean ED visits (+2.79); and one reported no change. Of these, 6 studies also reported reduced hospital costs. Only 1 study evaluating individualized care plans examined ED utilization and found no change in median ED visits post-intervention. Costs following individualized care plans were also only evaluated in 1 study, which reported savings in hospital costs of $742/patient. Evidence was mixed regarding information sharing: 1 study reported no change in mean ED visits and did not examine costs; whereas the other reported a decrease in mean ED visits (-16.9) and ED cost savings of $15,513/patient. CONCLUSIONS: The impact of all three frequent-user interventions was modest. Case management had the most rigorous evidence base, yielded moderate cost savings, but with variable reductions in ED use. Future studies evaluating non-traditional interventions, tailoring to patient subgroups or socio-cultural contexts, are warranted.

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Fig 1 PRISMA Flow Diagram. A total of 1491 abstracts were identified from the electronic database search. After removal of duplicate records, 1029 abstracts were reviewed and 952 were excluded. Hand-searching of the references lists of relevant systematic reviews identified 4 additional full-text articles. Eighty-one articles in all were assessed in full-text, of which 64 were excluded and 17 studies (4 randomized controlled trials; 13 comparative cohort studies), within 3 intervention categories (care or case management; individualized care plans; information sharing), were included for final qualitative synthesis. Heterogeneity in the reported outcomes prohibited pooling of data for meta-analysis.CC BY · PubMed Central

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Authors: Soril, L. J. J., Leggett, L. E., Lorenzetti, D. L., Noseworthy, T. W., & Clement, F. M.
Affiliations: O'Brien Institute for Public Health (CA)
Institute of Health Economics (CA)
Corresponding author: Clement, Fiona M.
ORCID: Soril, Lesley J. J.
Lorenzetti, Diane L.
Noseworthy, Tom W.
Clement, Fiona M.
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2015-04-13
Volume: 10
Issue: 4
Pages: e0123660
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0123660
PMC: PMC4395429
OpenAlex: W1965434882
Cited by: 251
References: 43
Citations by year: 2026: 18 · 2025: 17 · 2024: 13 · 2023: 34 · 2022: 28 · 2021: 32 · 2020: 31 · 2019: 22 · 2018: 24 · 2017: 17 · 2016: 14 · 2015: 1
FWCI: 4.35
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Figshare (submittedVersion, cc-by)
Topics: Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Keywords: frequent emergency department users, emergency department utilization, case management, individualized care plans, information sharing, hospital costs, cost reduction, intervention effectiveness
MeSH terms: Adult, Emergency Service, Hospital, Humans, Patient Care Planning, Quality Assurance, Health Care, Randomized Controlled Trials as Topic, Cost Savings, Hospital Costs, Case Management

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Reducing Frequent Visits to the Emergency Department: A Systematic Review of Interventions

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