Frequent hospital attenders at the acute receiving area of the Western Infirmary, Glasgow
In 1975, the medical staff at Glasgow's Western Infirmary suggested a
study of patients making frequent and inappropriate use of the
hospital IS acute receiving area. The staff claimed that these
patients seldom had acute medical problems; they wasted the doctors I
time; and consumed a substantial amount of hospital resources. The
staff wondered what prompted the behaviour of these patients and
whether they could be better managed in the future.
In order to identify the frequent and inappropriate users of the acute
receiving area, we reviewed the past acute attendances of the 3,284
patients in our patient sample. As we had no objective measures of
inappropriate patient behaviour, we used the frequency of
presentation as our sole selection criterion. knowinq that any
frequent and inappropriate users would thereby be included. After
samplinq the patient records. we defined frequent attendance as six or
more acute attendances between 1st January 1970 - 31st July 1975,
a 5 year 7 month study period. We found 150 (5%) of the 3,284
patients studied had been frequent attenders.
We looked for ways to identify the frequent attenders at presentation
but found no significant difference in age. sex. or presenting
complaint between the frequent attenders and the 3.284 patients
sampled. We then used these characteristics (age. sex, and presenting
complaint) to select matched controls from the patient sample for each
of the 120 frequent attenders who proved available for interview.
We found inappropriate use of the acute receiving area mentioned in
all but two of the 120 frequent attender records and 68% of the
frequent attenders' acute presentations were attributed to
inappropriate patient behaviour.
While few (12%) frequent attenders were diagnosed as having greater
medical problems than their matched controls, psychological problems
were diagnosed in 77% of the frequent attenders in contrast to only
22% of the controls.
The patients· answers at interview showed frequent attendance
strongly associated with a number of background variables, with no
single variable proving pathognomonic of frequent attenders. We found
that, on average, the frequent attenders had greater health, housing,
and employment problems, greater difficulties in relating to others,
and were more accident-prone than their matched controls.
We found most of the acute receiving area costs to be fixed costs and
thought little would have been saved had the frequent attenders not
presented. We thought the amount of hospital resources consumed by the
frequent attenders was too small to. adversely affect other patients.
Our study showed that a small number of frequent and inappropriate
users of the acute receiving area indeed existed at the Western
Infirmary. However, we thought that little could be done either to
alter the social and psychological factors we found associated with
frequent attendance or to prevent future acute attendances by these
patients. At a hospital level, we thought the costs and risks
involved in excluding the frequent attenders were outweighed by the
benefits of simply treating these patients. At a community level, we
thought that seeing the frequent attenders on demand in the acute
receiving area was an efficient and relatively inexpensive way of
supporting and maintaining these patients in the community.