Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Viola Korczak,Janani Shanthosh,Stephen Jan,Thomas Lung,Michael Dinh

doi:10.1186/s12873-019-0296-4

Abstract

BackgroundPrevious systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions.MethodA systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies.ResultsOne thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies.ConclusionThe majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.

Highlights

Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions
Of the 16 papers included in the review, all the papers were in English
This review showed that interventions targeting frequent presenters in emergency departments can have an impact in saving health care costs

Summary

Introduction

Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. Conclusion: The majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions. Frequent presenters to the ED have been found to be largely heterogeneous [8] [9], some generalisations can be made about this cohort. Limited research has been conducted on evaluating the costs and cost-effectiveness of these interventions compared to other hospital interventions

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Discussion

Conclusion