Heterogeneity of reasons for attendance in frequent attenders of emergency departments and its relationship to future attendance

Hotham, Richard; O’Keeffe, Colin; Stone, Tony; Mason, Suzanne; Burton, Christopher

doi:10.1136/emermed-2020-210412

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…SHarED participants’ locally determined criteria for identifying HIUs mirrored the lack of a single definition of HIUs in the literature,25–27 as local differences in population characteristics and services influence the heterogeneity of this diverse group of individuals with complex health needs 2 6 12 24–26 28 29…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, frequent ED attendance can be viewed as characteristic of a complex system, 22 which requires solutions at a system level as well as at the individual level, 22 23 thus, a systemwide approach has been recommended. 13 24 SHarED participants' locally determined criteria for identifying HIUs mirrored the lack of a single definition of HIUs in the literature, [25][26][27] as local differences in population characteristics and services influence the heterogeneity of this diverse group of individuals with complex health needs. 2 6 12 24-26 28 29 The SHarED programme, through the establishment of HIU teams and, more specifically through the use of PSPs, improved the working conditions and workload of frontline ED staff who were more able to provide appropriate and compassionate care and better manage HIUs' expectations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation

Sillero-Rejon,

Kirbyshire,

Thorpe

et al. 2023

BMJ Open Qual

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BackgroundThe need to better manage frequent attenders or high-impact users (HIUs) in hospital emergency departments (EDs) is widely recognised. These patients often have complex medical needs and are also frequent users of other health and care services. The West of England Academic Health Science Network launched its Supporting High impAct useRs in Emergency Departments (SHarED) quality improvement programme to spread a local HIU intervention across six other EDs in five Trusts.AimSHarED aimed to reduce ED attendance and hospital admissions by 20% for enrolled HIUs. To evaluate the implementation of SHarED, we sought to learn about the experience of staff with HIU roles and their ED colleagues and assess the impact on HIU attendance and admissions.MethodsWe analysed a range of data including semistructured interviews with 10 HIU staff; the number of ED staff trained in HIU management; an ED staff experience survey; and ED attendances and hospital admissions for 148 HIUs enrolled in SHarED.ResultsStaff with HIU roles were unanimously positive about the benefits of SHarED for both staff and patients. SHarED contributed to supporting ED staff with patient-centred recommendations and provided the basis for more integrated case management across the health and care system. 55% of ED staff received training. There were improvements in staff views relating to confidence, support, training and HIUs receiving more appropriate care. The mean monthly ED attendance per HIU reduced over time. Follow-up data for 86% (127/148) of cases showed a mean monthly ED attendances per HIU reduced by 33%, from 2.1 to 1.4, between the 6 months pre-enrolment and post-enrolment (p<0.001).ConclusionSHarED illustrates the considerable potential for a quality improvement programme to promote more integrated case management by specialist teams across the health and care system for particularly vulnerable individuals and improve working arrangements for hard-pressed staff.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation

Sillero-Rejon,

Kirbyshire,

Thorpe

et al. 2023

BMJ Open Qual

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“…9 This strategy is further supported by the finding that heterogeneity of presenting complaint, particularly with history of mental disorder, was found to be associated with further attendance in a UK study. 10 The exclusion of patient visits to a specialised psychiatric facility in this study by Pek et al restricts and potentially underestimates the rapidly increasing burden of mental illness among FAs. Overall, only 1.4% of FAs' reasons for visiting EDs were attributed to mental disorders, far lower than data published in the West where substance abuse and heavy drinking contribute significantly as reasons for visits to EDs by FAs.…”

mentioning

confidence: 83%

Frequent attenders to multiple emergency departments in Singapore

Kuan

Chua

2022

Ann Acad Med Singap

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The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide. 1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input) exacerbates overcrowding. Frequent attenders (FAs), defined as those having 4 or more visits to the ED per calendar year, 2 are known to utilise incommensurate amount of resources and drive up ED input. 3 The recognition of this issue prompted The Royal College of Emergency Medicine in the UK to publish a best practice guideline and recommendations to manage FAs. 4 Although numerous papers have been published from single-centre EDs to better understand the characteristics of these patients, several statewide studies highlighted the possibility for underestimation of the magnitude of the problem as FAs may have the propensity to visit multiple EDs in the same region.In this issue of the Annals, Pek et al. characterised FAs at multiple Singapore public hospital EDs and compared them to those who only attend a single ED frequently. 5 The authors benefited from Singapore being an island nation, which enabled a retrospective analysis of nationwide ED de-identified electronic health database between 2006 and 2018. This is the longest longitudinal study on FAs in Singapore conducted thus far from a large database. They introduced a novel concept of "mixed" FAs-those who attend single and multiple EDs in different calendar years. This categorisation was made to anticipate the likelihood of variability in ED attendance patterns among these patients-which were indeed shown in some of the results-versus FAs of multiple EDs and single ED. The authors discovered that about half of FAs visited multiple EDs (38.9%) or were mixed FAs (12.6%), who would have otherwise been missed out from single-centre studies. Notwithstanding trend data showing a decline in proportion of FAs from 19.8% in 2006 to 17.1% in 2018, the absolute number is still substantial and warrants attention. Among factors found to be associated with multiple ED and mixed FAs were younger patients, males, multiple comorbidities, and median triage class of higher severity. These patients were also much more likely to visit EDs more than 7

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“…Moreover, frequent ED attendance can be viewed as characteristic of a complex system [22], which requires solutions at a system level as well as at the individual level [22,23], thus, a system-wide approach has been recommended [13,24]. SHarED participants' locally determined criteria for identifying HIUs mirrored the lack of a single definition of HIUs in the literature [25][26][27], as local differences in population characteristics and services influence the heterogeneity of this diverse group of individuals with complex health needs [2,3,12,[24][25][26]28,29].…”

Section: Ed Staff Surveymentioning

confidence: 99%

Improving care for high impact users of hospital emergency departments: a mixed-method evaluation of a regional quality improvement programme ‘Supporting High impact users in the Emergency Department’ (SHarED)

Sillero‐Rejon

Kirbyshire

Thorpe

et al. 2023

Preprint

View full text Add to dashboard Cite

Background The need to better manage frequent attenders or high-impact users (HIUs) in hospital emergency departments (EDs) is widely recognised. These patients often have complex medical needs and are also frequent users of other health and care services. The West of England Academic Health Science Network launched its Supporting High impAct useRs in Emergency Departments (SHarED) quality improvement programme to spread a local HIU intervention across six other EDs in five Trusts. Aim SHarED aimed to reduce ED attendance and hospital admissions by 20% for enrolled HIUs. To evaluate the implementation of SHarED, we sought to learn about the experience of staff with HIU roles and their ED colleagues, and assess the impact on HIU attendance and admissions. Methods We analysed a range of data including semi-structured interviews with 10 HIU staff; ED staff training; an ED staff experience survey; and ED attendances and hospital admissions for 148 HIUs enrolled in SHarED. Results Staff with HIU roles were unanimously positive about the benefits of SHarED for both staff and patients. SHarED contributed to supporting ED staff with patient-centred recommendations and provided the basis for more integrated case management across the health and care system. 55% of ED staff received training. There were improvements in staff views relating to confidence, support, training, and HIUs receiving more appropriate care. The mean monthly ED attendance per HIU reduced over time. Follow-up data for 86% (127/148) of cases showed a mean monthly ED attendances per HIU reduced by 33%, from 2.1 to 1.4, between the six months pre- and post-enrolment (p<0.001). Conclusion SHarED illustrates the considerable potential for a quality improvement programme to promote more integrated case management by specialist teams across the health and care system for particularly vulnerable individuals and improve working arrangements for hard-pressed staff.

show abstract

Heterogeneity of reasons for attendance in frequent attenders of emergency departments and its relationship to future attendance

Cited by 5 publications

References 20 publications

Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation

Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation

Frequent attenders to multiple emergency departments in Singapore

Improving care for high impact users of hospital emergency departments: a mixed-method evaluation of a regional quality improvement programme ‘Supporting High impact users in the Emergency Department’ (SHarED)

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