Working Together to Connect Care: a metropolitan tertiary emergency department and community care program

2018 ◽  
Vol 42 (2) ◽  
pp. 189 ◽  
Author(s):  
Debra Harcourt ◽  
Clancy McDonald ◽  
Leonie Cartlidge-Gann ◽  
John Burke
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Case Management ◽  
Community Support ◽  
Care Program ◽  
Community Services ◽  
Management Approach ◽  
Frequent Users ◽  
Frequent Attendance ◽  
Working Together

Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a ‘frequent attendee’ was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of ‘super users’ is small compared with non-frequent users, the presentations are high. People in the frequent attendee group will often seek care from multiple EDs for, in the main, mental health issues and substance abuse. Furthermore, frequent ED users are vulnerable and experience higher mortality, hospital admissions and out-patient visits than non-frequent users. Aggressive and assertive outreach, intense coordination of services by integrated care teams, and the need for non-medical resources, such as supportive housing, have positive outcomes for this group of people. What does this paper add? This study uses international research findings in an Australian setting to provide a testing of the generalisability of an assertive and collaborative ED and community case management approach for supporting people who frequent a metropolitan ED. What are the implications for practitioners? The chronicling of a process undertaken to affect change in a health care setting supports practitioners when developing processes for this cohort across different ED contexts.

scholarly journals Screening of mental health and substance users in frequent users of a general Swiss emergency department

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Francis Vu ◽  
Jean-Bernard Daeppen ◽  
Olivier Hugli ◽  
Katia Iglesias ◽  
Stephanie Stucki ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Substance Users ◽  
Frequent Users

scholarly journals Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department

2007 ◽  
Vol 31 (3) ◽  
pp. 462 ◽  
Author(s):  
Scott Brunero ◽  
Greg Fairbrother ◽  
Soung Lee ◽  
Martin Davis
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Clinical Characteristics ◽  
Mental Health Problems ◽  
Total Sample ◽  
Health Problems ◽  
Case Review ◽  
Management Planning ◽  
Frequent Attendance ◽  
Metropolitan Hospital

The objective of this study is to determine the clinical characteristics of people with mental health problems who frequently attend an Australian emergency department (ED). A retrospective clinical audit of presenter characteristics was conducted in a 550-bed tertiary referral metropolitan hospital with data reflecting 12 months of consecutive ED presentations between September 2002 and August 2003. A sample of 868 individuals accounted for 1076 presentations. Patients attending more than once accounted for 12.5% of the total sample. Significant variables associated with frequent attendance included: younger age; English speaking background; and mood and anxiety disorders. Lone arrival of a patient to the ED showed marginal significance. The significant associates of frequent attendance found in this study may be used to identify patients earlier to a multidisciplinary case review process and individual management planning involving clinicians, carers and patients.

Commissioning for health and community sector reform: perspectives on change from Victoria

2020 ◽  
Vol 26 (4) ◽  
pp. 332
Author(s):  
Kate Silburn ◽  
Virginia Lewis
Keyword(s):  
Mental Health ◽  
State Government ◽  
Service Providers ◽  
Community Support ◽  
Models Of Care ◽  
Community Services ◽  
System Level ◽  
Reform Process ◽  
Structured Interviews ◽  
Competitive Tendering

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.

scholarly journals Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Patrick Bodenmann ◽  
Venetia-Sofia Velonaki ◽  
Ornella Ruggeri ◽  
Olivier Hugli ◽  
Bernard Burnand ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomised Controlled Trial ◽  
Case Management ◽  
Study Protocol ◽  
Controlled Trial ◽  
Frequent Users ◽  
Randomised Controlled

scholarly journals Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

2018 ◽  
Vol 19 (2) ◽  
pp. 238-244 ◽  
Author(s):  
Casey Grover ◽  
Jameel Sughair ◽  
Sydney Stoopes ◽  
Felipe Guillen ◽  
Leah Tellez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Case Management ◽  
Frequent Users

scholarly journals Characteristics of Psychiatric Patient's Use of One Emergency Department and Crisis Services and Comparison of Models of Care for Patients with Borderline Personality Disorder in the Frequency of Use of Emergency Services

2019 ◽  
Author(s):  
Ramamohan Veluri ◽  
Stacey Roles ◽  
Roberta Heale ◽  
Vicky P. K. H. Nguyen ◽  
M. Elizabeth Renouf
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Department ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Urgent Care ◽  
Frequent Users ◽  
Care Services ◽  
Ed Visits

Abstract Background: The cost of urgent mental health care services is high, both to the system as well as the individual and strategies that prevent these visits are paramount. Frequent users of the emergency department (ED) are a small percentage of ED patients but account for a large percent of visits. In particular, studies show that those patients with borderline personality disorder commonly present to urgent care. Given the rising number of ED visits and the corresponding cost to the health care system, it is important to explore strategies for avoidable or preventable visits to the ED, coupled with directing resources that ensure access to appropriate quality care. Methods: This research was a prospective chart review of the population of frequent users diagnosed with psychiatric illness in the (ED) and crisis (CRI) services at one hospital. Detailed analysis revealed characteristics of the patients who presented to the ED and CRI with a mental health diagnosis. Additional analysis of the subgroup of these patients with borderline personality disorder and/or self-harming behaviour was completed to determine the impact of the model of psychiatric care on subsequent crisis or ED visits in the year after the index visit. Results: The majority of patients presenting for mental health issues did so once. The mean number of subsequent presentations to the ED was 5.00 demonstrating that a small number of patients presented many times. Male patients were trending toward significance for number of ED and CRI visits. Patients with borderline personality disorder and/or self-harming behaviours in a model of care that offered increased access to services were less likely to visit the ED and CRI. Conclusions: Unstable or complex patients with psychiatric issues often present at the ED and CRI. Accessibility to community care services has the potential to reduce the number of ED and CRI visits and is a critical factor when considering this less stable group.

Benefits of a Recovery-Oriented Knowledge Translation Program for Mental Health Community Support Teams: A Qualitative Study

2021 ◽  
pp. 1-16
Author(s):  
Catherine Briand ◽  
Danielle Routhier ◽  
Régis Hakin ◽  
Brigitte Vachon ◽  
Rose-Anne St-Paul ◽  
...  
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Knowledge Translation ◽  
Scientific Evidence ◽  
Community Support ◽  
Healthcare Services ◽  
Developed Countries ◽  
Community Services ◽  
Health Community ◽  
Collaborative Platform

In most developed countries, health systems are attempting to compensate for underuse scientific evidence and its integration into healthcare services and practices. This qualitative study aimed to identify perceived benefits of a knowledge translation program implemented within mental health community services ((At your fingertips, Quebec, 2016-2018)). Results suggests that the production of a collaborative platform composed of a variety of activities and techno-educational tools, derived from integrated knowledge, facilitates the uptake by professionals in a context of reflective practices. Dissemination of these tools through technology of information and communication provides access to best recovery-oriented practices at your fingertips.

Identifying Characteristics of Frequent and Highly Frequent Users of the Emergency Department: A Cross-Sectional Observational Study

2020 ◽  
Author(s):  
Byeung Ki An ◽  
Tiffany Jane Lee ◽  
Sang Mi Kim ◽  
Suck Ju Cho ◽  
Joonbum Park
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Observational Study ◽  
Care Program ◽  
Future Research ◽  
Cross Sectional ◽  
Frequent Users ◽  
Logistic Regression Models ◽  
Ed Overcrowding ◽  
Ed Visits

Abstract Introduction: Since the characteristics of frequent emergency department (ED) users are heterogeneous, it is impossible to mitigate the overcrowding of the ED without the basic data of diagnoses and risk factors of frequent ED users. Our study will provide invaluable information that will help predict patient demand for medical resources while also providing important information that can be used to improve emergency medical services. Methods This is the cross-sectional observational study using records from The Korea Health Insurance Review Agency. Frequent ED users were defined as patients who visited an ED more than 7–17 times per calendar year and highly frequent ED users were defined as patients who visited an ED eighteen or more times during the same period. The diseases were ranked by prevalence in each of the three ED frequency groups (less frequent, frequent, and highly frequent ED user groups). Our study then developed two logistic regression models comparing frequent users with less frequent users and highly frequent users with frequent users. Standardized ß values were used to rank risk factor importance. Results Although less frequent ED users composed 98.98% of all patients, they only consisted of 92.27% of all ED visits. Compared with less frequent users, a greater proportion of frequent ED users were aged 65 years or older and were insured by Medicaid or Veterans Affair Health Care Program. Frequent ED users were also most strongly defined by wound dressing follow-up visits and liver diseases (standardized ß value of 3.29 and 2.31). However, this study did not show highly frequent ED users differed from frequent ED users in regard to the different disease categories. Conclusion The diagnoses and risk factors related to frequent ED visits in Korea identified in this study will be an important reference for future research aimed at reducing ED overcrowding. By further analyzing the risk factors associated with frequent ED use, non-emergency administrative systems or medical facilities can be utilized to reduce the overload on the ED.

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