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

Managing the needs of frequent attenders of urgent care services: a case management approach

BACKGROUND

Frequent service users, frequent attenders and high intensity users comprise a small proportion of emergency department (ED) visits but have a significant effect on cost and workload and are often ineffectively managed in healthcare settings. A new frequent service user manager (FSUM) service was set up in west Kent. This service used a case management approach to address the issue of frequent ED attendance and to support the well-being of these patients.

AIM

To evaluate a pilot FSUM service designed to address the frequent use of urgent care services.

METHOD

Service data on demographics, loneliness, anxiety, quality of life and urgent care service use were obtained for 24 frequent service users in one west Kent ED. Interviews were also undertaken with a sample of these patients ( n =4) to capture their experiences of using the FSUM service.

RESULTS

The main presenting symptoms for attending the ED were pain and alcohol-related issues. After 12 months of the FSUM service, loneliness, anxiety and use of urgent care services had reduced. The participants' quality of life improved from baseline to four months, but then stabilised at 12 months.

CONCLUSION

This evaluation demonstrated the value of taking a case management approach to address the needs of frequent service users. Healthcare services must encourage the appropriate use of urgent care services to reduce system pressures, but also to improve the well-being of patients.

Supporting frequent attenders to reduce their visits to an emergency department

Frequent attenders to emergency departments (EDs) are a heterogeneous group who have traditionally been patched up and discharged with little support. This makes them vulnerable to over investigation and they often have a poor experience in EDs, which can cause frustration among the staff who work with them. This article reviews the literature on frequent ED attenders and explores the related issues. It also describes how a multidisciplinary team (MDT) was formed to identify people in this group, evaluate their attendances and notes to understand their individual needs and identify strategies to improve their options and care while in the ED. The rationale for the formation of the MDT, the process of selecting patients and the interventions commonly used are discussed, as well as the benefits to patients, staff and the trust.