Strategies to manage emergency ambulance telephone callers with sustained high needs: the STRETCHED mixed-methods evaluation with linked data.

Objectives:Patients who frequently call ambulance services are a vulnerable yet heterogeneous population with unmet multiple and complex physical health, mental health and/or social care needs. In this article, we report the challenges that the COVID-19 pandemic has introduced for ambulance services across the UK when managing frequent callers, and reflect on how existing systems and practices are adapting to support changing patient needs.Methods:Data reported in this article comprise reflections from the frequent caller leads in each ambulance service in the UK. All data were provided between 23 April 2020 and 1 May 2020, shortly after the peak of the outbreak in the UK. A single anonymised case study is also reported to illustrate how the pandemic is affecting people’s circumstances and contributing to frequent caller behaviour.Results:Ambulance services are observing changes to the frequent caller population, with many new frequent callers due to health anxiety caused or exacerbated by the pandemic. Management of frequent callers is also changing, with multidisciplinary and multi-agency working becoming more challenging due to decreased access to external services, whether in social care or the community and voluntary sector, and the redeployment of ambulance service staff. There is also decreased face-to-face contact with frequent callers, meaning that opportunities to deliver person-centred care are reduced. However, the introduction or increased use of tele/video conferencing with other organisations has mitigated some of these challenges, and in some cases has improved engagement among external organisations.Conclusions:Health anxieties, lack of access to other health, social and community and voluntary sector services and exacerbations of social isolation and/or loneliness have reportedly contributed to changing behaviour among frequent callers. The COVID-19 pandemic has also affected how ambulance services have been able to manage frequent callers. Ambulance services should continue to engage with external organisations to aid the delivery of person-centred care, particularly organisations with experience in multiple complex needs such as mental health, social isolation and/or loneliness. Future research should examine the consequences of the pandemic for frequent users of ambulance services, and how these impact on the wider health and care community.

BackgroundA minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care...

To: (a) describe how telephone nurses define a frequent caller; and (b) describe their experiences with calls from frequent callers to primary healthcare centres. Telephone nursing has been noted to be a cost-effective method to enhance access to and use of health care. Some patients use these services extensively and are called 'frequent callers'. Little is known about this group of callers, the reasons behind these calls and telephone nurses' experiences and strategies to manage the calls. Descriptive design with a qualitative inductive approach. Interviews were conducted with ten telephone nurses in Sweden in 2015. Qualitative content analysis was conducted. A main theme was established, called 'Balancing between the experienced and assessed needs', which described the telephone nurses' experiences with calls made by frequent callers to primary healthcare centres and was further described in five categories with 15 subcategories. The categories described telephone nurses' definitions of frequent callers, telephone nurses' views of the underlying reasons for the calls, challenges related to frequent callers, experiences with an increased work load and strategies used to manage and help frequent callers. Frequent callers were commonly encountered by telephone nurses' in this study. Their calls were experienced as complex and demanding to manage. The findings point to needs for guidelines and routines to improve the care of frequent callers. In addition, support and training in communication skills to encounter this group of callers in an optimal and safe way may be required.

BackgroundA frequent caller is defined by The Frequent Caller National Network (FreCaNN) as an adult who makes five or more emergency calls in a month or twelve or more in three months, related to individual episodes of care. However, we believe that when limiting the definition to those who call themselves, one underestimates the impact frequent contacts have on the Emergency Medical Communication Center (EMCC) and the Emergency Medical Services (EMS).MethodWe conducted a descriptive retrospective cross-sectional database review of frequent contacts; defined as persons who have ≥ 5 contacts in a month or ≥ 12 contacts in three months. Data were provided from Oslo EMCC, between 1. January 2017 and 31. December 2022. Contrary to the FreCaNN definition, we included all types of contacts and callers, both emergent and non-emergent, regarding patients of all ages.ResultsDuring the study period, 2.149.400 contacts were registered. Of these 129.700 were contacts from frequent callers, where the patients called themselves. When including contacts frequently made on behalf of a patient, we found that 268.723 fit the definition of frequent emergency contacts. When also taking non-emergent contacts into account, a total of 437.361 contacts fit the definition of frequent contacts.ConclusionWhen limiting the criteria to only frequent callers, one underestimates the impact persons who have frequent contacts, have on the EMCC and the EMS. We were able to distinguish between three categories—contacts from frequent callers, frequent emergency contacts, and frequent contacts. We believe broadening the definition can benefit both research and audits, when accessing the use of emergency resources to patients with frequent requests for help to the EMCCs.

Frequent callers present a challenge for crisis helplines, which strive to achieve optimal outcomes for all callers within finite resources. This study aimed to describe frequent callers to Lifeline (the largest crisis helpline in Australia) and compare them with non-frequent callers, with a view to furthering knowledge about models of service delivery that might meet the needs of frequent callers. Lifeline provided an anonymous dataset on calls made between December 2011 and May 2013. We assumed calls from the same (encrypted) phone number were made by the same person, and aggregated call level data up to the person level. Individuals who made 0.667 calls per day in any period from 1 week to the full 549 days for which we had data (i.e. 4.7 calls in 7 days, 20 calls in 30 days, 40 calls in 60 days, etc.) were regarded as frequent callers. Our analysis dataset included 411,725 calls made by 98,174 individuals, 2594 (2.6%) of whom met our definition of frequent callers. We identified a number of predictors of being a frequent caller, including being male or transgender, and never having been married. The odds increased with age until 55-64 years, and then declined. Suicidality, self-harm, mental health issues, crime, child protection and domestic violence issues all predicted being a frequent caller. Collectively, frequent callers have a significant impact on crisis lines, and solutions need to be found for responding to them that are in everybody's best interests (i.e. the frequent callers themselves, other callers, telephone crisis supporters who staff crisis lines, and those who manage crisis lines). In striking this balance, the complex and multiple needs of frequent callers must be taken into account.

BackgroundA significant limitation in the literature on frequent callers and frequent users of prehospital Emergency Medical Services (EMS) is the lack of consistent and thus, comparable definitions, as well as inconsistent use of terminology. Here we aim to summarise and address discrepancies in the existing literature, contributing to the ongoing discussion.MethodWe conducted a systematic search of available literature from 2000 up until February 2024 in the PubMed database. Search terms related to both frequent callers and frequent users of the prehospital EMS.ResultA total of 19 articles were included in our analysis of definitions of frequent callers and users of prehospital EMS. The average minimum number of calls required to be defined as a frequent caller was 42.5 calls per year (range: 4-120). For frequent users, an average minimum number of ambulance responses was 4.7 per year (range: 3–10).ConclusionOur findings emphasise both the possibility and the need to distinguish between frequent users and frequent callers of prehospital EMS. Existing definitions in the literature vary widely, making comparisons difficult. Standardised definitions and consistent terminology are essential to address underlying issues and enable further research synthesis.

Background: Frequent callers are known to place significant stress on ambulance services through decreased system efficiency and increased costs. Frequent callers often have interconnected and complex physical, mental and social needs, which bring them into contact with ambulance services. Aims: This review synthesised evidence on strategies to mitigate frequent caller impact on ambulance services while meeting callers' individual needs. Methods: Major databases were systematically searched for relevant studies and critically appraised. Main themes were analysed and reported on. Findings: Preliminary evidence indicates that mass-distribution letters, case-management and caller-management systems may reduce frequent caller impact. Ambulance services require clear definitions and identification systems; information should be shared between services and multi-component strategies explored. Understanding the reasons behind calls can enable more personalised, effective care. Conclusion: Initial evidence points to promising frequent caller reduction strategies but further high quality research is urgently needed to confirm their effectiveness and support implementation.

Summary We conducted a systematic review of research into callers making multiple calls to crisis helplines. Two databases were searched, identifying 561 articles from 1960 until 2012, of which 63 were relevant. Twenty-one articles from 19 separate studies presented empirical data about callers making multiple calls to crisis helplines. Of the 19 studies, three were intervention studies, five were surveys of callers and 11 were call record audits. Most studies were conducted in the USA and defined frequent callers as people making two or more calls. Frequent callers were more likely to be male and unmarried compared to other callers. There were no reported differences between frequent callers and other callers with regard to age, mental health conditions or suicidality. Three studies tested interventions designed to better manage frequent callers. These studies, even though small, reported reductions in the number of calls made by frequent callers. Suggested techniques for responding to frequent callers included: limiting the number and duration of calls allowed, assigning a specific counsellor, implementing face to face contact, the service initiating contact with the caller instead of waiting for callers to contact the service, providing short term anxiety and depression treatment programmes by telephone, and creating a specific management plan for each frequent caller. Future work requires robust study design methods using larger sample sizes and validated measurements.

IntroductionUK ambulance services have identified a concern with high users of the 999 service and have set up ‘frequent callers’ services, ranging from within-service management to cross-sectoral multidisciplinary case management...

Objectives To provide and test different definitions of a frequent caller to the prehospital emergency medical services, grounded in both literature and empirical data, in order to spark discussion about definitions and how to make studies on frequent callers more comparable. Methods A cross-sectional register study of emergency calls made to the Emergency Medical Coordination Center (EMCC) covering the Central Denmark Region in 2022. Three definitions were developed: one as the average number of calls derived from definitions in the previous literature, while the other two were determined using a data-driven approach, representing the top 1% and 0.5% most frequent callers. Unadjusted logistic regression was used to measure odds ratios to examine non-causal associations between predictive factors and frequent callers within each definition. Results The analysis included 65,522 emergency calls concerning 49,623 unique individuals. For this specific population, the definitions resulted in the following three thresholds; literature-based definition: ≥43, top 1%: ≥5, and top 0.5%: ≥8 emergency calls per year. There was great variation between the populations of frequent callers captured by the three definitions. Across definitions, frequent callers constituted a relatively small proportion of the total population contacting the EMCC, while they made a significant share of the calls. Conclusions We suggest that the 1%-definition is the most suitable for future research on frequent callers to the prehospital EMS as it was able to account for the complexity of this group of citizens and could be applied across prehospital EMS in other contexts and countries. Based on this definition, the most characteristic patterns in emergency calls from frequent callers were low level of urgency, recontact within 24 h, and more calls due to behavioral, psychological, and unclear problems compared to non-frequent callers.

Objective: Very little has been articulated in the literature about strategies for managing frequent callers to helplines. This study aims to explore and clarify the current model of care for callers using helplines frequently due to their complex mental, physical and social needs. Methods: Semi-structured interviews were conducted with 10 senior clinical supervisors at four national helplines in Australia. The study took place between April and October, 2017. A thematic analysis was conducted to identify the main strategies used for the management of frequent caller cases. Results: The raw data themes emerging from the semi-structured interview transcripts were combined into four overarching main themes (i) undertaking case review; (ii) developing case coordination/management plans; (iii) staff supervision and support and (iv) outcomes of case coordination. Discussion: These results indicate that helplines use a systematic model of care for managing frequent callers that has not appeared in the previous research. Better integration between helplines and face-to-face services is required for the mental healthcare of clients with complex needs. This study provides the foundation to develop best practice guidelines for supporting frequent callers.

Clinical predictors of frequent patient telephone calls in Parkinson’s disease

BackgroundThere appears to be a paucity of studies examining the characteristics and impact of frequent users upon emergency medical services (EMS).ObjectiveTo review current primary research on frequent users of EMS...

BackgroundAmbulance services across the UK have recognised a clinical and operational problem with persistent high users of the 999 service, but there is a lack of evidence about what works...

BackgroundFrequent users of emergency medical services (EMS) comprise a disproportionate percentage of emergency department (ED) visits. EDs are becoming increasingly overwhelmed and a portion of use by frequent callers of EMS is potentially avoidable. Social factors contribute to frequent use however few studies have examined their prevalence. This study aims to describe social isolation/loneliness, poverty, and quality of life in a sample of frequent callers of EMS in the Hamilton region, a southern Ontario mid-sized Canadian city.Study designCross-sectional quantitative study.MethodsWe surveyed people who called EMS five or more times within 12 months. A mailed self-administered survey with validated tools, and focused on four major measures: demographic information, social isolation, poverty, and quality of life.ResultsSixty-seven frequent EMS callers revealed that 37–49% were lonely, 14% had gone hungry in the preceding month, and 43% had difficulties making ends meet at the end of the month. For quality of life, 78% had mobility problems, 55% had difficulty with self-care, 78% had difficulty with usual activities, 87% experienced pain/discomfort, and 67% had anxiety/depression. Overall quality adjusted life years value was 0.53 on a scale of 0 to 1. The response rate was 41.1%.ConclusionsLoneliness in our participants was more common than Hamilton and Canadian rates. Frequent EMS callers had higher rates of poverty and food insecurity than average Ontario citizens, which may also act as a barrier to accessing preventative health services. Lower quality of life may indicate chronic illness, and users who cannot access ambulatory care services consistently may call EMS more frequently. Frequent callers of EMS had high rates of social loneliness and poverty, and low quality of life, indicating a need for health service optimization for this vulnerable population.