Burton, C. orcid.org/0000-0003-0233-2431, Stone, T. orcid.org/0000-0002-0167-3800, Oliver, P. orcid.org/0000-0002-9665-0635 et al. (3 more authors) (2021) Frequent attendance at the emergency department shows typical features of complex systems : analysis of multicentre linked data. Emergency Medicine Journal, 39 (1). pp. 3-9. ISSN 1472-0205
Abstract
Objective: Frequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system.
Methods: Analysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation.
Results: The data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts’ data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients’ frequent attendance was unstable between years.
Conclusions: ED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 Author(s) (or their employer(s)). This is an author-produced version of a paper subsequently published in Emergency Medicine Journal. This version available under the terms of the Creative Commons Attribution-NonCommercial Licence (http://creativecommons.org/licenses/by-nc/4.0/). |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 16 Dec 2021 14:23 |
Last Modified: | 01 Mar 2022 14:48 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Refereed: | Yes |
Identification Number: | 10.1136/emermed-2020-210772 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:181686 |
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