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Understanding 'What Did I Do?' - Service Design for Frequent ED Attendance

This service design approach explores the stereotyped, costly, and burdensome frequent attendance at the Emergency Department. It aims to identify the sub-groups causing the most reversible impact, despite challenges in defining and characterizing this complex population. The focus is on Mental Health-related Frequent Attenders (MFAs) with somatoform disorders, Long-Term Conditions (LTC), self-harm or alcohol issues, and a special emphasis on the needs of the workgroup of frequent attenders. The project utilizes data from 20,965 attendances to create personas like James, Bob, and Kelly, offering valuable insights and lessons learned. Recommendations include developing proactive services for MFAs and targeted case management for EFA to address the high percentage of repeat attendances. Acknowledgments are extended to key stakeholders in addition to highlighting that 15% of frequent attenders are repeat cases, constituting 50% of all attendances. This project seeks to inform the improvement of services and provide a comprehensive understanding of ED frequent attendance patterns.

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Understanding 'What Did I Do?' - Service Design for Frequent ED Attendance

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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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