Abstract
Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.
Highlights
What do we already know about this topic? Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED and typically receive ED care that is less satisfying to them than infrequent ED users
How does this research contribute to the field? Findings indicate that ED healthcare providers experience a wide range of challenges related to FUED cares
Findings provide a broader understanding of challenges related to FUED and the needs and supports required for ED staff to address FUED complex needs
Summary
Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED and typically receive ED care that is less satisfying to them than infrequent ED users. Findings indicate that ED healthcare providers experience a wide range of challenges related to FUED cares. Findings provide a broader understanding of challenges related to FUED and the needs and supports required for ED staff to address FUED complex needs. Providing ED staff with support and tailored tools to help them address FUED complex needs may be accomplished by implementing case management intervention tailored to FUED in ED. Switzerland has universal health coverage, relying on mandatory individual health insurance, enabling access to care
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