What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom

Abstract

BackgroundEmergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern. Our objectives were to describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.MethodWe conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.ResultsTwelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600–900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre; contact made with callers; and their General Practitioner (GP) with an aim of discouraging further calls, to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. Although data were available related to volume of calls and number of callers meeting the threshold for definition as Frequent Caller, no formal audits or evaluations were reported.ConclusionsAmbulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Multi-disciplinary case management approaches may help to provide appropriate care, and reduce demand on emergency services. However, there is currently inadequate evidence to inform commissioning, policy or practice development.

Exploring the potential for social prescribing in pre‐hospital emergency and urgent care: A qualitative study

“…Frequent users of emergency medical systems can sometimes be difficult to identify (Maruster et al, 2020), and interventions have demonstrated promise, but still lack robust data on effectiveness requiring further evaluation (see e.g. Agarwal et al, (2019) and Snooks et al, (2019)). Social prescribing therefore has the potential to be an alternative or supplementary approach to support patients within the pre-hospital emergency and urgent care setting and to reduce the burden on emergency departments and primary care.…”

Paediatric frequent use of emergency medical services: a systematic review

“…[2][3][4] Studies of frequent EMS use have focused largely on adult populations, where a combination of physical health, mental health and social problems including isolation and loneliness contribute to frequent use. [5 6] There are now efforts to proactively identify and manage adult frequent EMS users to better meet their needs, [7][8][9] however, there are significantly different challenges associated with managing paediatric patients in the EMS setting. [10] Evidence from the Emergency Department (ED) setting, where one in 11 children who use the service do so frequently, [11] suggests that management of paediatric patients who use services frequently can result in positive outcomes.…”

Disparities in Emergency Care Among Patients with Mental Illness

“…However, even intensive campaigns often fail to maintain behavioural changes since some patients will keep reaching out to the healthcare system through the emergency system. [149][150][151] This support the contradictory theories that we may miss the opportunity to assist these patient when they reach out for help, and that emergency services could be better prepared for taking care of these patients. 150,[222][223][224][225][226] In high-income countries, there is an increasing demand to reduce the number of ambulance dispatches and hospital admissions by reducing 'preventable' or 'avoidable' contacts.…”

“…[149][150][151] This support the contradictory theories that we may miss the opportunity to assist these patient when they reach out for help, and that emergency services could be better prepared for taking care of these patients. 150,[222][223][224][225][226] In high-income countries, there is an increasing demand to reduce the number of ambulance dispatches and hospital admissions by reducing 'preventable' or 'avoidable' contacts. 127,146,147 In this scenario, it can be seen as contradictory to define an overall 'lower utility of emergency services' as a stand-alone outcome measure, since there may already be an underuse or barriers to access high-quality medical care in these groups.…”

“…However, even high-cost interventions (campaigns, case-based management) often fail to maintain behavioural changes in the vulnerable groups who will reach out to the healthcare system through the emergency system. [149][150][151] Utility measures are also part of the Danish Quality Improvement Programme, 32 e.g., 'avoidable hospital contacts among elderly' and 'acute hospital admission for diabetes or COPD'.…”