Introduction Patients who repeatedly attend the emergency department (ED) often have underlying complex social, psychological and chronic medical issues which are difficult to address in the emergency/acute medicine environment alone. Their attendances not only present a burden to the ED, but also can be a sign that the patient’s primary issue has been insufficiently addressed. At West Suffolk Hospital, we are trialling an approach to reduce frequency of ED attendances in a specific cohort of patients identified as being frequent attenders. In order to do this, we are using a multi-disciplinary approach including psychiatry services and ED clinicians.
Methods Our cohort of frequent attenders were identified as patients presenting more than 4 times to ED between March 2017 to April 2018. Exclusion criteria was if the patient is under 18 years old, has known long term medical conditions and known safeguarding concerns. With collaborative working by the emergency medicine clinician and liaison psychiatry, a letter was sent to 38 patients in May 2018, identifying them as frequent attenders and inviting them to a tailored multi-disciplinary team meeting. Initially we are assessing the impact of the letter, so 6 months after the letters were sent out, we assessed patient attendances again. 2 patients were excluded due to moving out of area and being in prison. Paired sample for means t-test was used to compare attendances pre- and post-intervention.
Results There were a wide range of presenting complaints to ED, most of which were psychiatric related – overdose, deliberate self harm, alcohol/drug related. The intervention letter improved the attendance rate the most in this cohort, whereas it had a negligible effect on attendances with physical complaints. The average fall in attendance was 33% in the 6 months post patients receiving the intervention letter. This reached significance level with p=0.039.
Conclusions Sending frequent attender patients a letter and putting in place a care plan could significantly reduce Emergency Department attendances. However there were a small number of patients, making it difficult to assess the efficacy of our intervention especially when adjusting for patient relocation.
We are hoping to disseminate the locally trialed strategy region wide across East Anglia, providing many more data points. We can also implement the model not just in patients with psychiatric background, but also patients with chronic medical problems too with additions to the multi-disciplinary team as per the needs of the patient.
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