Emergency clinician perceptions of patients who present frequently to the emergency department: a snapshot of current practice
Viola Korczak A B C * , Hueiming Liu C , Kendall Bein A B , Thomas Lung C D , Stephen Jan C D and Michael Dinh A B D EA Emergency Department, Royal Prince Alfred Hospital, NSW, Australia.
B Royal Prince Alfred Green Light Institute, 50 Missenden Road, Camperdown, NSW 2050, Australia.
C The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW 2042, Australia.
D Faculty of Medicine and Health, University of Sydney, NSW, Australia.
E NSW Institute of Trauma and Injury Management, Level 4/67 Albert Avenue, Chatswood, NSW 2067, Australia.
Australian Health Review 47(2) 226-233 https://doi.org/10.1071/AH22160
Submitted: 10 April 2022 Accepted: 1 November 2022 Published: 1 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective This study aimed to assess emergency clinician perceptions of adult patients who present frequently to the emergency department (ED) in an Australian context and understand current practices.
Methods ED clinicians including general practitioners, career medical officers and nurse unit managers working at New South Wales Australia level 3–6 hospitals were surveyed. Responses to open-ended questions were independently coded by two reviewers and the main themes were analysed.
Results Almost all the 210 participants (99%) could identify a population of frequent ED presenters at their hospital. Participants suggested that 9–12 presentations per year was a useful benchmark to use to characterise frequent ED presentations. They also indicated the need to consider as criteria recurrent presentations, their complexity, disease category and timeframe. Participants believed that the cause for presentation, from a restricted list of clinical alternatives, was multifactorial but the single most common cause for presentation was thought to be mental health followed by drug and alcohol. A total of 73% of participants reported that their hospitals had interventions to address frequent ED presentations, most commonly case management, multidisciplinary meetings and staff specialist involvement. Lack of co-ordination between services and a lack of resources in ED were cited as barriers to improving outcomes for patients who frequently present.
Conclusions ED clinicians surveyed offered suggestions on how to characterise frequent ED presentations beyond the number of visits to better identify this higher risk population. Additional services, as well as better coordination between patients, families, hospitals and outpatient services, appear needed in order to improve outcomes for this cohort of patients. Interventions should focus on increasing health outcomes, rather than a decrease in the number of presentations alone.
Keywords: emergency medicine, equity, health outcomes, health policy, health systems.
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