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The Scientific World Journal
Volume 2012 (2012), Article ID 726568, 6 pages
Research Article

Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

1Department of Public Policy, Health Care for the Homeless, 421 Fallsway, Baltimore, MD 21202, USA
2Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA
3Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Suite 200, Baltimore, MD 21201, USA

Received 26 October 2011; Accepted 15 December 2011

Academic Editor: Stefano Butto

Copyright © 2012 Barbara Y. DiPietro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs) in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86%) were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain ( 𝑛 = 9 ), lack of housing ( 𝑛 = 6 ), alteration of consciousness ( 𝑛 = 6 ), infection with human immunodeficiency virus (HIV) ( 𝑛 = 5 ), and nausea/vomiting ( 𝑛 = 5 ). Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.