Alcohol-Related Frequent Attenders to Emergency Departments: A Scoping Review with Implications for Singapore.

Background/

Objectives

Alcohol-related frequent attenders (ARFAs) constitute a small but resource-intensive emergency department (ED) population.

Methods

Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, CINAHL Complete, and EMBASE from inception to May 2025 for empirical studies examining ED frequent attendance with alcohol involvement. Definitions had high heterogeneity; therefore, narrative synthesis was conducted.

Results

A total of 73 studies were included, most retrospective (57.5%), encompassing sample sizes from 14 to over 4.1 million participants: 59 frequent attender (FA) studies with alcohol subgroup analyses and 14 pure ARFA studies. Research was concentrated in North America and Europe (56/73, 76.7%), with limited Asia-Pacific representation (21.9%). Seven distinct definition threshold categories were identified (≥2 to ≥20 visits annually); 31.5% utilised different definitions. Qualitative studies (n = 6) identified push factors (dependence, mental health crises, housing instability, fragmented services) and pull factors (24/7 access, crisis care model, immediate service) driving frequent attendance. Eight studies evaluated interventions; all employed non-randomised designs examining case management, integrated pathways, and community-based treatments.

Conclusions

Critical gaps include the absence of standardised definitions for comparison across studies, a concentration of research in Western settings limiting global applicability, and insufficient rigorous intervention evidence. Priorities include developing empirically validated definitions, expanding non-Western research, and conducting randomised controlled trials with adequate follow-up.