Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design

Abstract

Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p<0.001) but not with gender (p>0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate.

Frequent attenders at primary care out-of-hours services: a registry-based observational study in Norway

“…The characteristics of very frequent or extreme attenders (≥ 10, ≥ 20, and ≥ 30 consultations) were similar to persistent FAs, with a larger percentage of females and more psychological and social problems than ordinary FAs. This is in line with other studies of very frequent or extreme FAs [ 4 , 12 , 13 ]. We also found that extreme FAs tended to seek help at inconvenient hours (late evening and night), and increasingly so the more extreme they were.…”

“…Only rarely have children been included in studies [ 6 ]. Usually, FAs are characterized by psychological disorders [ 4 , 6 , 10 – 13 , 19 – 21 ] and social disorders [ 10 , 22 , 23 ], but also chronic somatic disease has been reported as more common among FAs [ 10 , 11 , 20 ].…”

Can more appropriate support and services be provided for people who attend the emergency department frequently? National Health Service staff views

“…Their attendances are usually associated with complex underlying social, emotional and health-related problems,2 which are difficult to address within the ED environment alone 34.…”

Assessment and management of recurrent abdominal pain in the emergency department

“…In 2016, the UK saw 23.5 million attendances in ED, an increase of 5.2% compared with 2015, which eqautes to around 2210 people attending an ED department each day 1. A recent review of 13 million ED attendances found that over 31 000 people attended ED > 10 times in a year (high-impact user status2), placing a significant economic burden on healthcare systems 2 3. In the USA, the Centre for Disease Control and Prevention (CDC) reported 146.5 million ED attendances 4.…”

“…Medically unexplained symptoms, also known as ‘persistent physical symptoms,15 is a broad term used to describe individual symptoms or clusters of symptoms that persist in the absence of medical pathology to fully explain presenting physical symptoms. Around 45% of high-impact users who present to the ED have no detectable medical pathology,3 a high proportion of which include abdominal pain. Medically unexplained symptoms are characterised as multifaceted, effecting functioning in cognitive, emotional, behavioural, affective and social dimensions.…”