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Emergency Department
Frequent referral

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Jahanian, F., Khatti, S., Salehi, A., Aminiahidashti, H., & Montazer, S. H. (2019). Evaluating the Causes and Frequency of Frequent Referral to the Emergency Department of Imam Khomeini Educational Hospital in Sari. Internal Medicine and Medical Investigation Journal, 4(2). https://doi.org/10.24200/imminv.v4i2.199

Evaluating the Causes and Frequency of Frequent Referral to the Emergency Department of Imam Khomeini Educational Hospital in Sari

Fatemeh Jahanian
Sahar Khatti
Alireza Salehi
Hamed Aminiahidashti
Seyed Hossein Montazer

Introduction: Emergency department is one of the most important units of a hospital. In general, the most serious cases are referred to emergency department, and the highest numbers of hospital admissions occur in the emergency department. This study aimed to obtain a comprehensive estimate of the number of frequent visitors to the emergency department of Imam Khomeini educational hospital, Sari. Materials and Methods: This cross-sectional descriptive study was performed retrospectively by referring to the patient medical records at the Sari Imam Khomeini education hospital. The records were screened to identify frequent emergency department visitors in 2017. Data analysis was performed using SPSS 21. Results: The number of emergency department visitors in the Sari Imam Khomeini Hospital in 2017 was 29,765; of them, 594 (6.2%) were repeat visitors and were included in this study. The mean age of the frequent emergency department visitors was 56.17 years. The most common complaint was weakness and lethargy in 39.9% patients, abdominal pain in 30%, shortness of breath in 14%, and other causes in 14%. The most common underlying disorders were anemia, followed by obstruction pulmonary disease. Conclusion: We obtained detailed data of frequent emergency department visitors to aid the development of suitable evidence-based policies. New policies are necessary for the management of various sections of the emergency department and inpatient admissions. Such policies will allow better decision-making for non-emergency patients and outpatient admissions.



Javadi S, Salimi T, Sareban MT, Dehghani MA. Knowledge and Practice of Nurses Regarding Patients’ Triage in Emergency Department. Iranian J Emerg Med. 2016;3(1):15-22

Woo JH, Grinspan Z, Shapiro J, Rhee SY. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study. PloS One. 2016;11(1):e0147450.

Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernández‐Frankelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004;11(1):38-50

LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42-8

Krieg C, Hudon C, Chouinard M-C, Dufour I. Individual predictors of frequent emergency department use: a scoping review. BMC Health Serv Res. 2016;16(1):594

Lucas RH, Sanford SM. An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med. 1998;32(5):563-8

Kalantarimeibidi M, Yadollahi A, Esfandiari S. The effect of education on the knowledge and practice of emergency department’s nurses regarding the patients’ triage. Ṭibb-i urzhāns-i Īrān. 2014;1(1):40-4

Esmailian M, Zamani M, Azadi F, Ghasemi F. Inter-rater agreement of emergency nurses and physicians in Emergency Severity Index (ESI) triage. Emergency. 2014;2(4):158

Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med. 2006;48(1):9-16

Pascasie K, Mtshali NG. A descriptive analysis of emergency department overcrowding in a selected hospital in Kigali, Rwanda. Afr J Emerg Med. 2014;4(4):178-83

Karpiel M. Improving emergency department flow. Healthc exec. 2004;19(1):40

Zohoor A, Pilevar Zadeh M. Study of speed of offering services in emergency department at Kerman Bahonar hospital in 2000. Razi J Med Sci. 2003;10(35):413-9

Topacoglu H, Karcioglu O, Ozucelik N, Ozsarac M, Degerli V, Sarikaya S, et al. Analysis of factors affecting satisfaction in the emergency department: a survey of 1019 patients. Adv Ther. 2004;21(6):380-8

Banerjea K, Carter AO. Waiting and interaction times for patients in a developing country accident and emergency department. Emerg Med J. 2006;23(4):286-90

Richardson JD, Franklin G, Santos A, Harbrecht B, Danzl D, Coleman R, et al. Effective triage can ameliorate the deleterious effects of delayed transfer of trauma patients from the emergency department to the ICU. J Am Coll Surg. 2009;208(5):671-8

Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8

Norman C, Mello M, Choi B. Identifying frequent users of an urban emergency medical service using descriptive statistics and regression analyses. West J Emerg Med. 2016;17(1):39

Ismailia M, Talebpoor M, Mehrabi KA. Frequency Distribution of Re-Hospitalization and Related Factors in Patients Discharged in 12 Hours from AL Zahra Hospital Emergency Service, Isfahan, Iran during 2015 Spring and Summer. JIMS. 2016;34(371):98

Mandelberg JH, Kuhn RE, Kohn MA. Epidemiologic analysis of an urban, public emergency department's frequent users. Acad Emerg Med. 2000;7(6):637-46

Castillo EM, Brennan JJ, Killeen JP, Chan TC. Identifying frequent users of emergency department resources. J Emerg Med. 2014;47(3):343-7

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