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Addressing ED Frequent Attendance: Reducing Stereotypes and Costs

Explore a service design approach to tackle the high cost and burden of ED frequent attendance. Who is causing the greatest reversible impact on our ED? Dive into challenges faced by the complex and heterogenous population, especially MH-related FA personas. Learn from data and personas like James, Bob, and Kelly to inform new services. Recommendations include proactive measures for MFAs and case management for EFAs. Acknowledgements to Cecily Morrison, Cathy Walsh, and CPFT FA working group for their contributions.

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Addressing ED Frequent Attendance: Reducing Stereotypes and Costs

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  1. What did I do? A service design approach to ED frequent attendance Stereotyped image – high cost & burden; inappropriate use Question: Who (which sub-group/persona) is causing the greatest reversible impact on our ED? vs • Complex and heterogenous population; difficult to define and characterise

  2. Challenges? • MH-related FA Personas: • MFA with MUS/somatoform • MFA with LTC • EFA with self harm or alcohol • Frequent attenders workgroup – stakeholder views • Challenges of stereotypes • Needs amalgamation → incoherent design; elastic user • Data (20,965 attendances) → personas • How will project inform new service? James 30 times Bob 14 times Alcohol misuse and ODs chest pain but no significant ischaemic disease found Kelly 10 times recent diagnosis of COPD Personasamples

  3. Lessons learnt Recommendations: MFA – Given 97% of FAs are MFAs, need to develop proactive service to identify, assess and treat those that fall within the MFA personas EFA – Target through case management Acknowledgements: Cecily Morrison (EDC) Cathy Walsh (Liaison Psychiatry) CPFT FA working group Addenbrooke’s ED • 15% of FAs are repeat FAs but account for 50% of attendances • FAs have 1 in 4 chance of re-attending within 7 days • Moderate (<20/yr) vs Extreme (>20/yr) FAs • 97% of FAs are MFAs Persona samples

  4. % of total attendances by FAs % of patients attending 6 times or more/year

  5. MFA vs EFA

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