Abstract
Introduction
Frequent use of the emergency department (ED) is an important indicator of the performance of health and social care systems. The aim of this scoping review was to describe patients experiencing high use of the ED, identifying their health and sociodemographic characteristics, and to compare the definitions of high use across studies.
Methods
A scoping review of repeat use of the ED was conducted in Medline, PsycINFO, EMBASE, CINAHL Ultimate and Web of Science in July 2025 by two independent reviewers. The search was limited to studies from Canada, Australia, New Zealand, and the United Kingdom given the similarities in the organization of their healthcare systems. Information on patient characteristics was abstracted and themes were narratively described. The PRISMA-ScR was used for the reporting of the review.
Results
The review included 52 studies of which 22 were from Canada, 16 from Australia, 9 from the UK, and 5 from New Zealand. There was significant variation in the definition of frequent use, ranging from 2 visits in three years to 20 or more visits in a year. Most of the included studies defined frequent ED users as ≥ 4 visits within 12 months. The gender distribution of patients with frequent ED use was about equal and mean age ranged from the mid-40s to mid-50s. Individuals often presented with multiple chronic diseases, including mental health or substance use disorders. Socioeconomic status, such as employment or housing situation, was assessed in thirteen studies.
Conclusions
Patients with frequent ED use represent a heterogeneous population with complex health and social needs More consistent reporting of social determinants, such as homelessness and socioeconomic status, is essential in order to better capture the social context of frequent ED use. A standardized cut-off is required to improve comparability across studies and support future research.
Key messages
• Definitions of frequent ED users are highly heterogeneous, but most of included studies define frequent use as four or more visits within a 12‑month period.
• Further research on social determinants, including socioeconomic status and homelessness, is needed to better characterize patients with frequent ED use.