REVIEW ARTICLE Review article: People who present on multiple occasions to emergency departments Katherine Nelson, 1 Margaret Connor, 1 Cynthia Wensley, 1 Cheryle Moss, 3 Margaret Pack 1 and Tania Hussey 2 1 Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, 2 Wellington Hospital Emergency Department, Capital and Coast District Health Board, Wellington, and 3 School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia Abstract Research about people who present on multiple occasions to the ED began in the 1980s. Despite this, little is known of their journey as patients. Understanding ED use as a journey can help clinicians improve how they meet the needs of this patient group. Multiple terms were used to identify research on the use of the ED. Papers were included if they had a primary focus on multiple presentations by the general ED population. Integrative review methods were used to extract findings related to the patients’ journeys. The findings confirm a sequence of events and processes that provide an outline of the journey through the experience of people who present on multiple occasions. The journey concerns people’s decisions to present and re-present to the ED, their assessments on arrival, dilemmas of treatment, outcomes of care and long-term health outcomes. This patient group often have high and complex health needs, engage extensively with other health services and have poor long-term health outcomes. The issue of multiple presentations to the ED is complex and ongoing because of the morbidity of the people concerned, the preference of patients to attend, the purpose of the ED and preparation and role of the personnel and the difficulties with continuity of care. The provision of care for people who present on multiple occasions can be improved within the ED and health services generally through a better understand- ing of presentations. Key words: decision-making, hospital emergency service, utilization. The journey of people who present to EDs multiple times is an important concept. Such a concept gives coherence to the experience of how these people often live with complex health circumstances. The journey provides a lens on their vulnerability and demonstrates the importance of clinicians understand- ing the interwoven pattern of patient perceptions, decision-making and health needs, which result in the process of becoming a regular attendee of the ED. Since the 1980s 1,2 researchers have sought to describe the multiple attendances to the ED from different per- spectives and to find solutions to reduce the heavy use of the ED by some people. Given this 30 year timeframe we considered it timely to review and integrate this Correspondence: Dr Katherine Nelson, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, PO Box 7625, Newtown, Wellington 6242, New Zealand. Email: kathy.nelson@vuw.ac.nz Katherine Nelson, PhD, RN, Senior Lecturer; Margaret Connor, PhD, RN, GSNMH, Research Fellow; Cynthia Wensley, MHSc, RN, GSNMH, Lecturer; Cheryle Moss, PhD, RN, Director (Community Engagement), Associate Professor Nursing, Research and Practice Development; Margaret Pack, PhD, RSW, Lecturer; Tania Hussey, RN, Emergency Nurse. doi: 10.1111/j.1742-6723.2011.01449.x Emergency Medicine Australasia (2011) 23, 532–540 © 2011 The Authors EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine