Frequent psychiatric visitors to a Veterans Affairs medical center emergency care unit

Objective: The study examined characteristics of patients who made repeat visits to the psychiatric emergency service of a Veterans Affairs medical center. Methods: Computer records of patients who visited the emergency service were retrospectively examined for a one year period after their index visit. Patients were divided into three groups according to the number of visits; nonrepeaters had only one visit, occasional repeaters had two or three visits, and frequent repeaters had four or more visits. Results: Of 1,144 patients who visited the emergency service during the one-year study period, 26 percent were occasional repeaters and 8 percent were frequent repeaters; the latter group accounted for 24 percent of all visits. Schizophrenic patients were overrepresented among frequent repeaters. Compared with nonrepeaters, repeat visitors were admitted to the hospital more often and were less likely to be referred to an outpatient clinic for follow-up. Frequent repeaters were more likely than occasional repeaters to revisit within one month and to visit during evening hours. Conclusions: One-third of patients seen during a one-year period revisited the emergency service, a rate substantially higher than those reported for large urban non-VA hospitals. The higher rate may have been due to the longer sampling period, to a more seriously ill population, or to fever community resources for veterans because of misperceptions about their eligibility.