Repeated use of the emergency department: qualitative study of the patient's perspective.

OBJECTIVE: To explore what lies behind repeated emergency department (ED) use, from the patients' own perspectives.
METHODS: Qualitative study based on in depth interviews with frequent users of the ED at the Huddinge University Hospital, Sweden. Ten adult patients having visited the ED 6-17 times in the previous 12 months were interviewed. The personal meaning they attached to the symptoms and their encounters at the ED were inductively analysed, thereby relating patient behaviour to life conditions.
RESULTS: The frequent ED visitors perceive pain or other symptoms as a threat to life or to personal autonomy. Irrespective of whether or not the patients relate their health problems to a traumatic event, overwhelming anxiety compels them to seek urgent help. Clear cut diagnoses are seldom mentioned. Although none of the patients is homeless or totally lacking in means, the narratives reveal struggles with adverse life circumstances and medical, psychological and/or social problems, including alcohol or other substance misuse. Occasional referrals from the ED to a psychiatrist seem not to lead to any continuous treatment or to a change in the patients' health seeking behaviour. Satisfaction with care becomes adversely affected when the patients perceive that the ED staff classifies their use of the ED as inappropriate or when their symptoms are belittled.
CONCLUSIONS: From their own perspectives, frequent ED visitors are in need of urgent care. It is particularly important to these patients that the personal meaning they attach to their symptoms is attended to and respected by the ED staff.