6-10 11-20 21-30 >30 #attendance/year (2010)

1. A service design approach to frequent attendance in the ED: moving from elastic users to personasMai Luen Wong & Cecily MorrisonLiaison Psychiatry Service, Cambridge University Hospitals Mary 16 times James 30 times Those who attend 5 – 20 times a year account for the majority of attendances by FAs. Bob 14 times chest pain but no significant ischaemic disease found recent diagnosis of COPD Alcohol misuse and ODs Number of individuals Kelly 20 times Small ODs or abdominal pain Clinical work, supported by an algorithmic scan of the data, suggested that some of the moderate FAs may have medically unexplained symptoms. Another potentially important group is patients with long term conditions. This work will also inform the new service for the extreme FAs. 6-10 11-20 21-30 >30 #attendance/year (2010) Frequent attendance (FA) to the emergency department is costly and more appropriate services for this population are needed. Initial meetings demonstrated that each stakeholder had a different conception of a frequent attender and the needs that a new service would address. This usually leads to an amalgamation of suggestions into an incoherent design, a common design problem referred to as the elastic user. This research project took a service design approach to address this problem, creating personas, concrete descriptions of the proposed service user groups. The personas were created through combining research evidence, easily accessible data for 2003 to 2010 from a clinical information system, and clinical knowledge to describe the local population of frequent attenders. Persona samples Jelinek et al find distinct clinical differences in FA groups. Those who attend between 5 and 20 times in a year (98% of FAs) have more problems with circulatory system disorders and unstable angina and often require urgent care. MJA 2008;186:552-556 Case sample: 52 y.o. man referred by ED SpR for Liaison Psychiatry assessment on 14th presentation with new onset chest pain over 6 months as it was felt his “presentations were out of proportion to degree of illness”. Diagnosis: Adjustment disorder with anxiety symptoms presenting with physical symptoms due to loss of work after the death of employer on a background of learning difficulties and social isolation. Intervention: Psycho-education, rationalisation of cardiac medications, referral to IAPT and Gateway support worker. Outcome: Presentation to ED reduced to 2 times over next 6 months