Defining "high-frequency" emergency department use: Does one size fit all for urban and rural areas?

Objective To suggest a functional definition for identification of "high-frequency" emergency department (ED) users in rural areas. Design Retrospective analysis of secondary data. Setting Sioux Lookout Meno Ya Win Health Centre in northwestern Ontario. Participants All ED visitors (N = 7121) in 2014 (N = 17 911 visits) in one rural hospital. Main outcome measures The number of patients and visits identified using different definitions of high-frequency use. Results By using the most common definition of high-frequency use (= 4 annual visits) for our hospital data, we identified 16.7% of ED patients. Using 6 or more annual visits as the definition, we identified 7.9% of ED patients; these patients accounted for 31.3% of the ED visit workload. Using the definition of 6 or more identifies less than 10% of the patients, which is a similar result to using the lower visit standard (= 4) in urban centres. Conclusion We suggest that the definition for high-frequency visitors to a rural ED should be 6 or more annual visits. Other useful subsets might include very high-frequency users (12 to 19 annual visits) and super users (= 20 annual visits).