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Improving care for emergency department frequent attenders

Emergency department sign

In September 2018 the Oxford AHSN received funding from the Health Foundation for a project to improve care for Emergency Department (ED) frequent attenders.

Since then we have been seeking to identify best practice and working with service users to explore how EDs can best assess their needs. We are working with clinical lead Dr Deon Louw, an ED consultant from Oxford University Hospitals. Progress so far was discussed at an event on 2 May 2019 which brought together teams from across the Thames Valley and beyond and received invaluable input from former high intensity service users.

The aim is to improve ED mental healthcare through peer support of teams across the Thames Valley incorporating the following objectives:

  • analysing data on attendance patterns to identify variation and overlap between departments throughout the region
  • sharing frequent attenders programme models across the Thames Valley region to identify and implement best practice and looking at which interventions may be particularly effective
  • involving service users to devise strategies that will enable us to understand and better meet their unique needs.

The initiative is scheduled to run from November 2018-November 2019.

Initial work involves contacting trusts and other organisations to find out more about local models for meeting the mental healthcare needs of frequent attenders in ED and obtain views on the project. We are also undertaking a literature review and finding out about other models in place across the NHS. This includes:

  • exploring with Thames Valley teams the different models in place locally
  • developing with service users a co-designed psycho-social assessment form to help standardise the way we understand some of the most complex patients
  • analysis of pseudonymised data sets to assess the extent to which patients may be frequently attending several EDs in the Thames Valley, allowing teams to collaboratively discuss strategies as well as seeking to understand the need this is meeting for service users.

We also plan to categorise and analyse already-collected anonymised detailed data sets within our EDs and use clinical knowledge and experience to determine which interventions produce the best outcomes, helping us design interventions to best help these service users.

Further analysis of pseudonymised datasets will allow organisations across the Thames Valley to see how patterns of use of services differ between areas, identifying unwarranted variation and allowing services to improve.

We propose to hold two workshops with partner organisations to share knowledge and ideas and inform developing improvement in local services. The workshops will include:

  • sharing best practice from within and outside the Thames Valley
  • reviewing research findings from a literature review
  • exploring what data is telling us about frequently attending patients including where there may be unwarranted variation
  • sharing methods from elsewhere to explore how organisations work together in each locality to provide services for ED frequent attenders
  • time for discussion in locality groups to identify potential plans and developments to services.

Further information:

  • Dr Deon Louw, Clinical Lead, Locum Consultant in Emergency Medicine, Emergency Department Lead for Mental Health, Oxford University Hospitals NHS Foundation Trust
  • Fran Butler, Programme Lead for Mental Health, Oxford AHSN
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