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Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non-emergency department (ED) interventions to reduce ED utilization: a scoping review. BMC Emerg Med 2024; 24:117. [PMID: 38997631 PMCID: PMC11242019 DOI: 10.1186/s12873-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. METHODS This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. RESULTS Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. CONCLUSION A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
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Affiliation(s)
- Målfrid A Nummedal
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sarah King
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sindre A Pedersen
- The Medicine and Health Library, Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Petter Bjørnsen
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Gallagher D, Bentley B, Barry A, Fraccola A, Santos R, Glenn A, Howard J, Kamath A, Flanagan K. Development of an Emergency Department Case Management Case-Finding Tool. Prof Case Manag 2024; 29:102-110. [PMID: 37982739 PMCID: PMC10984631 DOI: 10.1097/ncm.0000000000000699] [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] [Indexed: 11/21/2023]
Abstract
PURPOSE OF STUDY Identifying emergency department (ED) patients who are at high risk for return visits is an important goal for case management to improve patient care. This quality improvement study describes the development and evaluation of the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based "case-finding" system, and its ability to identify these high-risk patients. In addition, the authors present data about its acceptability among emergency department case managers (ED CMs). PRIMARY PRACTICE SETTINGS Emergency departments with case management availability and staffing. METHODOLOGY AND SAMPLE A retrospective analysis at Duke University Hospital ED compared patient data pre- and postimplementation of the EDCMPS. The tool was developed using the LEAN and Plan-Do-Study-Act (PDSA) quality improvement methodologies, with ED CM participation. ED return and hospitalization rates within 7 and 30 days between both methods were compared, and a survey evaluated CM satisfaction with the EDCMPS. RESULTS The 2-month preintervention period (July 1, 2022, to August 31, 2022) included 8,677 patients discharged from the ED, with 897 patients (10.3%) identified as at high risk for return based on the previous manual methodology. In the 3-month postintervention period (September 1, 2022, to November 30, 2022), there were 13,566 patients discharged, with 692 patients (5.1%) identified as at high risk for return using the EDCMPS. The EDCMPS outperformed the manual method, yielding a significantly higher odds ratio (OR) for 7- and 30-day ED return or hospitalization (e.g., 30-day any return OR = 4.21 vs. 1.69). The survey showed broad ED CM agreement on the tool's superior performance, especially in organizing outpatient resources and referring to support programs. However, challenges in securing primary care follow-up, housing, and health insurance applications were identified. The tool's collaborative development approach ensured its fit to ED CM needs, contributing to its success. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The EDCMPS showcases promise in enhancing ED CM efficiency, with strong frontline staff endorsement. It pinpoints areas needing focus for patient support and has the potential to reduce ED revisits and therefore health care utilization. Its methodology offers insights for similar future implementations in health care institutions.
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Affiliation(s)
- David Gallagher
- Address correspondence to David Gallagher, MD, SFHM, Duke University School of Medicine, DUMC Box 3508, Durham, NC 27710 ()
| | - Barbara Bentley
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Ashley Barry
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Amy Fraccola
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Rosimeire Santos
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Adam Glenn
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - James Howard
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Aparna Kamath
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Katie Flanagan
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
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Bodenmann P, Kasztura M, Graells M, Schmutz E, Chastonay O, Canepa-Allen M, Moullin J, von Allmen M, Lemoine M, Hugli O, Daeppen JB, Grazioli VS. Healthcare Providers' Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028173. [PMID: 34328025 PMCID: PMC8326990 DOI: 10.1177/00469580211028173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Patrick Bodenmann
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Oriane Chastonay
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Marina Canepa-Allen
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of
Pharmacy and Biomedical Sciences, Curtin University, Western Australia
| | - Michael von Allmen
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Melissa Lemoine
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne
University Hospital, University of Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of
Psychiatry, University of Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
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