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Moon F, Knott J, Feely S. Examining management plans for patients who frequently presented to the emergency department. Australas Emerg Care 2024; 27:114-118. [PMID: 37923610 DOI: 10.1016/j.auec.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patients who frequently present to Emergency Department (ED) experience complex health and social needs. While research has examined interventions that aim to decrease frequent ED attendances, there is a need to understand the types of interventions provided to patients by hospital clinicians during presentations. METHODS Using qualitative content analysis, 82 management plans were evaluated to understand the scope and type of interventions provided by clinicians for patients frequently presenting to the ED at the Royal Melbourne Hospital, Australia. RESULTS Patients often presented to the ED due to mental and psychological distress, substance use and physical health concerns alongside psychosocial vulnerabilities. The goals of care documented in plans focussed on management of health issues, aggression within the ED, and coordinating care with community services. Recommended interventions addressed presenting needs with multi-disciplinary approach to respond to distress and aggression. Finally, the plans provided insight into service coordination dynamics between the ED and community-based health and social care services. CONCLUSIONS The plans recommended interventions that sought to provide holistic care for patients in collaboration with relevant community-based services. The findings suggest that clinicians in the ED can provide appropriate and meaningful care for patients who experience frequent presentations.
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Affiliation(s)
- Felicity Moon
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Critical Care, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Siobhan Feely
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
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Sillero-Rejon C, Kirbyshire M, Thorpe R, Myring G, Evans C, Lloyd-Rees J, Bezer A, McLeod H. Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation. BMJ Open Qual 2023; 12:e002496. [PMID: 38114246 DOI: 10.1136/bmjoq-2023-002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
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 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. 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 6 months pre-enrolment 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.
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Affiliation(s)
- Carlos Sillero-Rejon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK, Bristol, UK
| | | | - Rebecca Thorpe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gareth Myring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK, Bristol, UK
| | - Clare Evans
- Health Innovation West of England, Bristol, UK
| | - Johanna Lloyd-Rees
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angela Bezer
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK, Bristol, UK
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Malakellis M, Wong Shee A, Murray M, Alston L, Versace VL, Allender S, Mc Namara K. A qualitative system model to describe the causes and drivers of frequent potentially avoidable presentations to the emergency department. Heliyon 2023; 9:e21304. [PMID: 38027925 PMCID: PMC10658286 DOI: 10.1016/j.heliyon.2023.e21304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Frequent potentially avoidable presentations to Emergency Departments (EDs) represent a complex problem, driven by multiple interdependent and interacting factors that change over time and influence one another. We sought to describe and map the drivers of frequent potentially avoidable presentations to a regional ED, servicing regional and rural areas, and identify possible solutions from the perspectives of key stakeholders. This study used a qualitative, community-based systems dynamics approach utilising Group Model Building (GMB). Data were collected from two 3-h online workshops embedded with small-group discussions and conducted with stakeholder groups operating within a regional health system. Stakeholders were guided through a series of participatory tasks to develop a causal loop diagram (CLD) using Systems Thinking in Community Knowledge Exchange software (n=29, workshop one), identify potential action points and generate a prioritised action list to intervene in the system (n=21, workshop two). Data were collected through note taking, real-time system mapping, and recording the workshops. Each action was considered against the Public Health 12 framework describing twelve leverage points to intervene in a system. A CLD illustrating the complex and interrelated factors that drive frequent potentially avoidable ED presentations was developed and classified into four categories: (1) access to services; (2) coordination; (3) patient needs; and (4) knowledge and skills. Nine action areas were identified, with many relating to care and service coordination. Most actions aligned with lower-level system impact actions. This study provides an in-depth understanding of influencing factors and potential solutions for frequent potentially avoidable ED presentations across a regional health system. The CLD demonstrates frequent potentially avoidable ED presentations are a complex problem and identified that a prevention response should engage with system- and individual-level solutions. Further work is needed to prioritise actions to support the implementation of higher-level system impacts.
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Affiliation(s)
- Mary Malakellis
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
- Grampians Health, Ballarat, Victoria, Australia
| | - Margaret Murray
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
- Colac Area Health Research Unit, Colac, Victoria, Australia
| | - Vincent L. Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
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Kuan WS, Chua MT. Frequent attenders to multiple emergency departments in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:460-461. [PMID: 36047520 DOI: 10.47102/annals-acadmedsg.2022216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore
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Mason S, Stone T, Jacques R, Lewis J, Simpson R, Kuczawski M, Franklin M. Creating a Real-World Linked Research Platform for Analyzing the Urgent and Emergency Care System. Med Decis Making 2022; 42:999-1009. [PMID: 35574663 PMCID: PMC9583284 DOI: 10.1177/0272989x221098699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background This article describes the development of a system-based data platform for
research developed to provide a detailed picture of the characteristics of
the Urgent and Emergency Care system in 1 region of the United Kingdom. Data Set Development CUREd is an integrated research data platform that describes the urgent and
emergency care system in 1 region of the United Kingdom on almost 30 million
patient contacts within the system. We describe regulatory approvals
required, data acquisition, cleaning, and linkage. Data Set Analyses The data platform covers 2011 to 2017 for 14 acute National Health Service
(NHS) Hospital Trusts, 1 ambulance service, the national telephone advice
service (NHS 111), and 19 emergency departments. We describe 3 analyses
undertaken: 1) Analyzing triage patterns from the NHS 111 telephone helpline
using routine data linked to other urgent care services, we found that the
current triage algorithms have high rates of misclassifying calls. 2)
Applying an algorithm to consistently identify avoidable attendances for
pediatric patients, we identified 21% of pediatric attendances to the
emergency department as avoidable. 3) Using complex systems analysis to
examine patterns of frequent attendance in urgent care, we found that
frequent attendance is stable over time but varies by individual patient.
This implies that frequent attendance is more likely to be a function of the
system overall. Discussion We describe the processes necessary to produce research-ready data that link
care across the components of the urgent and emergency care system. Making
the use of routine data commonplace will require partnership between the
collectors, owners, and guardians of the data and researchers and technical
teams. Highlights
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Affiliation(s)
- Suzanne Mason
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Tony Stone
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Richard Jacques
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Jennifer Lewis
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Rebecca Simpson
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Maxine Kuczawski
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
| | - Matthew Franklin
- School of Health Related Research, University of Sheffield, Sheffield, England, UK
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Than M, Richardson S, Pickering J. Emergency department frequent attenders: big data insights for a big and complex problem. Emerg Med J 2021; 39:2. [PMID: 34404679 DOI: 10.1136/emermed-2021-211560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Martin Than
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - Sandra Richardson
- Emergency Department, Christchurch Hospital, Christchurch, New Zealand
| | - John Pickering
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
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