High emergency department use in Europe: a scoping review

Background

Emergency departments (EDs) in Europe are under pressure due to overcrowding. Frequent and inappropriate emergency visits may lead to suboptimal resource use. Patients with high ED use (HEDU), although a small segment of the population, contribute disproportionately to the total number of visits. The review aimed to synthesize the knowledge on the characteristics of individuals with HEDU in the European Union (EU) and European Free Trade Association (EFTA).

Methods

A scoping review following JBI methodological guidelines was conducted using five databases: Ovid MEDLINE, PsycInfo, Embase, CINAHL Ultimate, and Web of Science up to July 2025, and all records were managed in Rayyan software. Two independent reviewers performed the screening and data extraction. The reporting followed PRISMA-ScR checklist.

Results

The scoping review included 28 quantitative studies carried out between 1990 and 2025 from nine countries. Most studies were conducted in Italy (n = 8, 29%), Ireland (n = 4, 14%) and Sweden (n = 4, 14%), with underrepresentation of Central and Eastern Europe (CCE). There was no uniform definition of HEDU (range: 2-17 visits/year). Several studies used higher cut-offs to describe super frequent attendance up to > 30 visits/year. Studies on children (n = 6, 21%) indicated that HEDU was more frequent among patients <3 years old and those with no nearby ED. Studies on adults (n = 10, 36%) showed that HEDU was common among individuals with mean age 55 years old, unemployment/social assistance, experiencing homelessness. HEDU was more likely to be reported among patients who were socially isolated and single or separated/divorced.

Conclusions

Given the varied HEDU definitions in Europe, drawing conclusions on its prevalence is challenging. Some studies analyzed few patient characteristics, which limits the knowledge on HEDU. Future research should encompass a wide range of patient characteristics to better understand it. Moreover, more evidence from CCE is needed.

Key messages

• Understanding patient characteristics contributing to high emergency department use in Europe is an essential step for developing tailored strategies aimed at optimising care provision.

• There is a need for a uniform definition of high emergency department use in Europe in order to improve the comparability between countries.