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

Abstract

Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.

Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study

“…Specifically to the FUED population, the findings from this study highlight the many inconveniences and limitations of the ED, particularly in the ability to meet the specific needs of the FUED population. These findings are consistent with previous research that revealed that ED staff and settings are typically not equipped to address the complex needs of FUED (e.g., social needs) [7]. As highlighted by a previous ethnographic study conducted in the ED [23], feeling unable to address these patients' needs may provoke anxiety among health care workers, which may, in turn, lead them to distance themselves from these patients.…”

“…This intervention might be developed through a participatory action research design and might aim to improve staff awareness through FUED testimonies and live exchanges [38]. In addition, given the fact that ED settings are typically not equipped to meet FUED complex needs and acknowledging the many difficulties encountered by health care workers [7,17,39], it may be important to provide them with additional ongoing supervision and coaching to help them navigate the complex situations presented by FUED. Furthermore, besides raising awareness among health care workers, it may be equally important to implement interventions specifically designed to address the complex needs of FUED in ED and primary care settings, such as case management [9,10,17,40].…”

“…Driving this high ED use are the often multiple social, medical, psychological and substance use difficulties they typically endure, coupled with frequently limited access to health care outside of the ED [3][4][5][6]. As a matter of fact, ED staff are generally not trained nor equipped to meet the complex needs of this population [7,8]. In response, and with the goal of improving the quality of care and thereby improving health equity for this population, interventions focusing on the FUED's specific needs, such as case management (CM), have been developed [9].…”

“…However, most of the research exploring FUED experiences with the health care system has been conducted in North America [18]. Additional qualitative explorations involving FUED in a socially and culturally different country, such as Switzerland, is needed to provide key insights into possible specific adjustments to improve the quality of FUED care provided in Switzerland [4,7,10,26]. Such explorations would provide insights for Swiss health care workers concerning FUED experiences.…”

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

“…Emergency physicians and most nurses do not have specific training or the time to determine psychosocial needs and most do not know what resources are out in the community to fill in the gaps. Social services are attached to EDs but are not sufficiently staffed and trained in empowerment, care pathways, health literacy and outreach techniques [ 25 ]. Although HM seems appropriate to reduce iterative ED use in this population, HM has never been evaluated in this context.…”