Aims and Objectives Background: People who attend the Emergency Department (ED) frequently are few in number, but have a significant impact on healthcare systems and communities. A clear link exists between high intensity use (HIU) and health inequalities, with drivers including housing insecurity, substance misuse, and physical and mental health problems. A district general hospital (DGH) currently supports this group of patients through monthly multidisciplinary team (MDT) meetings, and individual case management by two specialist nurses.

Aim: To establish the impact of HIU on ED services at one DGH, evaluate the current service offer to support frequent attenders, and propose improvements.

Method and Design Method: Data from all ED attendances in 12 months at one DGH were analysed. Frequent attendance was defined as ≥5 attendances in 12 months. Structured interviews were conducted with 11 MDT members regarding their experiences of supporting these patients and of the service. Open interviews were conducted with 3 patients for their experiences and reflections.

Results and Conclusion Results: People who attended ED ≥5 times in 12 months accounted for 2.6% of all patients (1,730), yet made up 12% of all attendances. 186 people attended ≥10 times in 12 months, costing approximately £2.8 million. Two thirds of frequent attenders are in Indices of Multiple Deprivation deciles 1-3, indicating relative deprivation. Frequent attenders are more likely than non-frequent attenders to arrive by ambulance (49% vs 25%) or police transport (1.7% vs 0.5%), are more likely to stay >4 hours (49% vs 35%), and be admitted to hospital (42% vs 27%).

The most valuable service reported to reduce ED attendances was individual case management. Working with patients to address social determinants of health increases their overall wellbeing, therefore reducing attendances.

Conclusion: HIU of ED continues to overwhelm resources, however expanding the case management service can reduce this to meet national targets, whilst simultaneously addressing health inequalities.