Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia

Objective To examine the characteristics of frequent visitors (FVs) to emergency departments (EDs) and develop a predictive model to identify those with high risk of a future representations to ED among younger and general population (aged 70 years). Design and setting A retrospective analysis of ED data targeting younger and general patients (aged 70 years) were collected between 1 January 2009 and 30 June 2016 from a public hospital in Australia. Participants A total of 343 014 ED presentations were identified from 170134 individual patients. Main outcome measures Proportion of FVs (those attending four or more times annually), demographic characteristics (age, sex, indigenous and marital status), mode of separation (eg, admitted to ward), triage categories, time of arrival to ED, referral on departure and clinical conditions. Statistical estimates using a mixed-effects model to develop a risk predictive scoring system. Results The FVs were characterised by young adulthood (32.53%) to late-middle (26.07%) aged patients with a higher proportion of indigenous (5.7%) and mental health-related presentations (10.92%). They were also more likely to arrive by ambulance (36.95%) and leave at own risk without completing their treatments (9.8%). They were also highly associated with socially disadvantage groups such as people who have been divorced, widowed or separated (12.81%). These findings were then used for the development of a predictive model to identify potential FVs. The performance of our derived risk predictive model was favourable with an area under the receiver operating characteristic (ie, C-statistic) of 65.7%. Conclusion The development of a demographic and clinical profile of FVs coupled with the use of predictive model can highlight the gaps in interventions and identify new opportunities for better health outcome and planning.