High use of the emergency department among patients in Krakow, Poland: An alternative to seeking primary care?

Context: Research from North America shows that a common reason for high emergency department (ED) use is the inaccessibility of primary care. Individuals who frequently attend the ED comprise up to 10% of patients, while accounting for a third of ED visits. There is a lack of information on high ED use in other jurisdictions, specifically in Central and Eastern Europe.

Objective: To describe frequent ED use among patients in Krakow, Poland.

Study Design and Analysis: A secondary analysis of administrative data was undertaken. Unscheduled ED visits from the 2022 calendar year were included in the descriptive analyses. Patient and visit-level data on gender, age, residence location, ambulance arrival, triage category, specialist consultations, ICD-10 discharge diagnosis, and hospital admission were analyzed. Cross-tabulations were used to summarize the categorical data, while continuous data were described using means and medians.

Setting or Dataset: Data were obtained from the hospital information system at the Jagiellonian University Hospital, which is a tertiary care academic centre in Kraków, Poland.

Population Studied: Adult patients (≥18 years of age) with high ED use (≥5 visits per year) were included.

Results: In 2022, there were 39,851 ED visits made to the hospital by 32,927 patients. 198 patients met the criteria for high ED use, accounting for 1,272 ED visits (mean: 6.4, SD: 2.2, median: 6, IQR: 2.0). Over half of these patients were female (n=101, 51.0%) and resided in Kraków (n=138, 69.7%). The mean age was 60.4 years (SD: 19.9, median: 65.5, IQR: 32.8). 45.2% (n=575) of the patients arrived by ambulance. 35.5% (n=451) of the patients were triaged as urgent and 50.8% (n=646) as standard. The most common specialist consultations in the ED were urology (9.7%), neurology (3.1%), and psychiatry (2.7%). The top discharge diagnoses were atrial fibrillation and flutter (n=62, 4.9%), unspecified abdominal pain (n=51, 4.0%), and COVID-19 (n=46, 3.6%). A third of the patients (n=438, 34.4%) were admitted.

Conclusions: This study explored high ED use in Kraków and found that 0.6% of the patients met this definition, accounting for 3.2% of all ED visits. This figure is lower than that found in other jurisdictions, such as in North America. The reasons for a lower proportion of patients experiencing high ED use could be multi-factorial, including a greater availability of primary care and an increased accessibility of community resources.