Abstract
Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017-2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire. RESULTS: Analysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.Clinical implicationsAn integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.Declaration of interestNone.
Highlights
This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency
This paper describes the development of a joint initiative between Hertfordshire Partnership University National Health Service (NHS) Foundation Trust and Watford General Hospital to offer standardised care to frequent attenders
Analysis of the results of the Hertfordshire Frequent Attenders Programme underscores that the most effective way of reducing inappropriate attendances and enhancing patient self-management is locating the frequent attender at the centre of the care plan
Summary
The largest number of frequent attenders were women in the 26–39 years age group. In terms of cost to the NHS, the most expensive group were the over 65 years age group of both genders These patients typically lived alone, had limited social networks and appeared to derive considerable comfort from the care and attention they received in the emergency department. Patients with alcohol dependence often lead chaotic lives and tend to present to the emergency department only when drunk, making a meaningful assessment difficult. They tend to ‘disappear’ for extended periods of time, either because they move between counties or because they are sentenced to prison sentences, typically for theft of alcohol. Their attendances trace a different pattern to other frequent attenders: typically, they have cycles of abstinence alternating with cycles of relapse
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