ABUHB High Impact Service - Multi agency working to support patients that frequently present to services

Aneurin Bevan University Health Board

There are various reasons behind why patients frequently present to emergency department (ED) and urgent care settings. Social crisis often drives re-attendances as it is linked with mental health / wellbeing, substance misuse, housing, social isolation / loneliness and domestic abuse. Additional causes of re-attendances include acute / chronic illness or conditions, poor health management, frailty and falls of the elderly cohort and medically unexplained symptoms.

High Impact Service Users contribute to the demand felt across health services. The majority of this patient group will have multiple contacts with the health service and other emergency services, along with statutory and non-statutory services. However, there was little to no coordination or communication between services, resulting in the user not being supported by the right service at the right time. In order to support and manage patients effectively a full multi-disciplinary / agency approach is needed.

The frequent attender (FA) case manager was a new role within Aneurin Bevan University Health Board in 2019. The initial scope was to case manage patients that frequently presented to the emergency department and look at how their attendances could be reduced. However critical review of the service and service user needs identified that case management alone was not sufficient to meet the needs of urgent and emergency care services.

Using a model initially based upon the Welsh Emergency Department Frequent Attender Network of holding a multi-agency monthly panel meeting to discuss patients that present to ED four times in four weeks, a High Impact Service was developed to provide safer care, reduce attendances and inappropriate investigations, and ensure that patients are seen by the right service at the right time.

The service has evidenced success in the reduction of presentations for complex patients, excellent multi agency working and improved outcomes for patients and staff. It has been shown that the service significantly improves the quality and safety of patient experiences.