An Emergency Department-initiated, Web-based, Multidisciplinary Approach to Decreasing Emergency Department Visits by the Top Frequent Visitors Using Patient Care Plans

Pillow, M. Tyson; Doctor, Shaneen; Brown, Stephen; Carter, Keme; Mulliken, Robert

doi:10.1016/j.jemermed.2012.08.020

Cited by 30 publications

(67 citation statements)

References 5 publications

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“…Although the literature review presented beneficial outcomes in providing intensive CM at somatic hospital based ED, the authors concluded that there was a need for further studies covering how best to take care of frequent visitors to ED. This is a conclusion which is supported by other researchers [8,[19][20][21]. In Sweden and, to our knowledge, no intervention study covering models for reducing costs and frequent visits at ED has been published.…”

Section: Introductionsupporting

confidence: 79%

“…However, during the last decades the function of somatic hospital based ED has gradually changed, mainly due to the characteristics of today's patients visiting ED. For example, studies from Western countries point out that patients nowadays' more often use somatic hospital based ED for reasons that are beyond somatic concerns and are in fact based on psychological and social reasons [3,7,8]. Prior studies has shown that ED frequent visitors are a psychosocial vulnerable group with poor mental health, low level of perceived social support and heavy users of general practitioners and other primary care forms [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

Persson¹

2014

Int J Nurs Clin Pract

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Background: Patients who repeatedly seek care directly at hospital based somatic emergency departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive. The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to a somatic hospital based ED; II) Eventual changes, over six months, in costs and patients' health care utilization related to pilot testing the model and III), the team's experiences of implementing the model. Methods: A mixed method convergent parallel design was used. Results:The development of the model began as a top-down process and later on into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 73 visits (55%). Conclusion:The inference quality description is that a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. Increased communication between different professionals within the hospital and between different caregivers such as ED, primary health care and community social-and health-care, increases the possibility for the patients to be cared for in a sustainable and non-fragmented way.

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Section: Introductionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

Persson¹

2014

Int J Nurs Clin Pract

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“…A variety of interventions to address their needs have been described. [12][13][14][15][16][17] Two existing systematic reviews 18,19 suggested that targeted interventions, particularly case management, may reduce ED visits. These reviews do not include several more recently published studies and their searches did not capture all available interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-one NCBA studies, [12][13][14][15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] six RCTs, 17,[41][42][43][44][45] and four CBA studies [46][47][48][49] examined interventions targeting adult frequent ED users. The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013). Most (n = 23) were published in peer-reviewed journals, [12][13][14][15][16][17][25][26][27][28][29][30][35][36][37][38][39]41,[44][45][46][47][48][49] five were scientific conference abstracts, [31][32][33][34]40 and two were protocols for planned RCTs. 42,43 Authors of primary studies were mainly from the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Moe

Kirkland

Rawe

et al. 2017

Academic Emergency Medicine

169

138

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Objectives: Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes.Methods: An a priori protocol was published in PROSPERO. Two independent reviewers screened, selected, rated quality, and extracted data. Third-party adjudication resolved disagreements. Rate ratios of post-versus pre-intervention ED visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users' ED visits and patient-oriented outcomes.Results: A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before-after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (n = 18), care plans (n = 8), diversion strategies (n = 3), printout case notes (n = 1), and social work visits (n = 1). Post-versus pre-intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range = 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease ED visits post-intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6-or 12-month follow-up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high. The authors have no potential conflicts to disclose. PROSPERO registration number CRD42014015058. Study group authorship: Jessica Moe conceptualized and drafted the protocol, screened abstracts and articles for inclusion, extracted data, analyzed data, and wrote the manuscript; Scott Kirkland helped to draft the protocol, screened abstracts and articles for inclusion, analyzed data, assessed study quality, and wrote sections of the manuscript; Erin Rawe drafted the protocol and extracted data; Maria Ospina helped to draft the protocol, assessed study quality, and provided third-party adjudication for inclusion screening and quality assessment; Ben Vandermeer helped to plan and perform the statistical analysis; Sandy Campbell developed and ran the search strategy; Brian H. Rowe conceptualized the protocol, provided third-party adjudication for inclusion screening and quality assessment, analyzed data, and wrote a section of the manuscript. All authors reviewed, edited, and approved the final manuscript. Existing evide...

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A New Model

Blatt¹

2014

Health, Science, and Place

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An Emergency Department-initiated, Web-based, Multidisciplinary Approach to Decreasing Emergency Department Visits by the Top Frequent Visitors Using Patient Care Plans

Cited by 30 publications

References 5 publications

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

A New Model

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