Health care providers’ perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland

Abstract

Background Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. Objectives The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. Methods Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. Results The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. Conclusions The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions.

Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

“…The larger survey included 19 closed and open-ended questions, in German, French, and Italian, (covering 99.2% of the Swiss population) assessing ED staff’s perception of FUED and interest in implementing CM. 16 Of those, the 2 questions exploring ED staff perceptions of challenges related to FUED care were used in the current study. Participants were asked to indicate the extent to which they perceive FUED to be problematic within their ED service, using a Likert scale ranging from 1 = a non-important problem to 4 = an extremely important problem .…”

“…An online survey was sent to all general adult emergency services in Switzerland. 16 In total, 64% of participants perceived important challenges around FUED. Findings also indicated that the majority of ED staff face FUED regularly, yet they feel poorly informed on how to manage them.…”

“…Interestingly, whereas more than 90% of ED staff thought that CM could be useful, less than 60% showed interest in implementing it. 16 Hence, despite a perceived need and interest in implementing CM, ED staff appear to face barriers adopting and implementing it.…”

Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

“…A 12-item online survey was developed to measure variables related to the FUED issue, summarized below and presented in Appendix 1. The survey was based on a version developed by a panel of experts involved with FUED and used in ongoing research [18,19]. As described in Chastonay et al [19], the panel conducted a series of sessions to develop a set of items exploring ED staff's perceptions regarding FUED and associated issues.…”

“…The survey was based on a version developed by a panel of experts involved with FUED and used in ongoing research [18,19]. As described in Chastonay et al [19], the panel conducted a series of sessions to develop a set of items exploring ED staff's perceptions regarding FUED and associated issues. The survey was tested by ED staff (Lausanne university hospital, CHUV; N = 14).…”