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Can more appropriate support and services be provided for people who attend the emergency department frequently? National Health Service staff views
  1. Suzanne Ablard,
  2. Elizabeth Coates,
  3. Cindy Cooper,
  4. Glenys Parry,
  5. Suzanne M Mason
  1. School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Elizabeth Coates, School of Health and Related Research, University of Sheffield, Sheffield, UK; e.coates{at}sheffield.ac.uk

Abstract

Background Interventions designed to help Emergency Department (ED) staff manage frequent attenders are labour-intensive and only benefit a small sample of frequent attenders. We aimed to use the in-depth knowledge of health professionals with experience of working with ED frequent attenders to understand the challenges of managing this group of patients and their opinions on providing more appropriate support.

Methods Semi-structured interviews were conducted with medical and nursing ED staff, mental health liaison nurses and general practitioners (GPs). Interviews covered the following: definitions and experiences of treating frequent attenders and thoughts on alternative service provision. Vignettes of frequent attenders were used to elicit discussions on these topics. Thematic analysis of transcribed interviews was undertaken.

Results Twelve health professionals were interviewed. Three groups of frequent attenders were identified: people with long-term physical conditions, mental health problems and health-related anxiety. Underlying reasons for attendance differed between the groups, highlighting the need for targeted interventions. Suggested interventions included improving self-management of long-term physical conditions; creating a ‘go-to’ place away from the ED for patients experiencing a mental health crisis; increasing the provision of mental health liaison services; and for patients with health-related anxiety, the role of the GP in the patients’ care pathway was emphasised, as were the benefits of providing additional training for ED staff to help identify and support this group.

Conclusion Interventions to address frequent attendance should focus on redirection to and liaison with more appropriate services, located on the hospital site or in the community, tailored to each identified patient group.

  • emergency department
  • mental health

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Footnotes

  • Contributors All authors contributed to the design of the study (SA, EC, CC, GP and SMM). SA and EC conducted the study including recruitment, data collection and data analysis. SA prepared the manuscript with important input from all of the authors (EC, CC, GP and SMM). CC, GP and SMM provided intellectual input throughout the entire project. All authors approved the final manuscript.

  • Funding The research was funded by the NIHR CLAHRC Yorkshire and Humber (www.clahrc-yh.nihr.ac.uk). The views expressed are those of the author(s), and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval NRES Committee Yorkshire and the Humber - Leeds East.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This is a qualitative study focused on the experiences and opinions of staff working in an ED. It is not possible to fully anonymise the data, and therefore the data generated are not suitable for sharing beyond that contained within the report. Further information can be obtained from the corresponding author.

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