Emergency Contact Research Articles

Real-Time Monitoring of Driver’s Biometrics to Prevent Multi-Vehicle Chain Collisions Caused by Impending Medical Emergencies

Smart healthcare systems are essentially going to become an inevitable part of our day to day activities. Sophisticated health monitoring devices will be used to provide a safer and less accident-prone society. Their use in active accident mitigation and management will extend, in the coming years, to not only our home atmosphere but will also include manufacturing, transportation, work-place and agricultural milieu. As a matter of fact, real time healthcare monitors have been introduced in some high-end, expensive luxury cars such as Mercedes-Benz and Tesla. The design proposed is a low-cost and affordable, continuous healthcare monitoring system which aims to extend the use Internet of Things (IoT) to vehicular systems. It is designed to detect anomalies in the driver’s health conditions and take preventive actions to prevent road accidents. These actions include steadily reducing the vehicle’s speed and ultimately stopping it. Simultaneously, an alarm or warning is relayed to the nearby vehicles of the impending emergency that has occurred, thus cautioning them of a possible accident. An emergency message is spontaneously relayed to the concerned medical personnel and to the emergency contacts–relatives of the driver.

Perceptions of non-caregiving roles among siblings of adults with intellectual and developmental disabilities

Siblings have the longest familial tie. Further, when a disability is present in the family, siblings may also fulfil various roles for their brothers and sisters with intellectual and developmental disabilities, such as friend, role model, caregiver, and guardian. To date, most research has focused on the caregiving roles of siblings. However, many siblings do not anticipate fulfilling caregiving roles; yet there is little extent research examining the perceptions of adult siblings toward non-caregiving roles. Thus, it is important to identify other perceived roles of adult siblings of individuals with intellectual and developmental disabilities. This study involved the secondary analysis of a national dataset of 70 non-caregiving, adult siblings of individuals with intellectual and developmental disabilities in the United States. Such perceived roles included supporter, typical sibling, no role, service coordinator, guardian, advocate, and emergency contact person. Implications for future research and practice are discussed.

Low Rates of Screening for Celiac Disease Among Family Members

Given the increased morbidity and potential mortality of celiac disease, guidelines recommend screening high-risk individuals, including first-degree relatives of patients. We assessed how commonly celiac disease testing occurs in these individuals and identified factors that influence testing. Relatives of 2081 patients with biopsy-diagnosed celiac disease and followed up at Columbia University Medical Center were identified using relationship inference from the electronic health record-a validated method that uses emergency contact information to identify familial relationships. We manually abstracted data from each record and performed univariate and multivariate analyses to identify factors associated with testing relatives for celiac disease. Of 539 relatives identified, 212 (39.3%) were tested for celiac disease, including 50.4% (193 of 383) of first-degree relatives and 71.5% (118 of 165) of symptomatic first-degree relatives. Of the 383 first-degree relatives, only 116 (30.3%) had a documented family history of celiac disease. On multivariate analysis, testing was more likely in adults (odds ratio [OR], for 18-39 y vs younger than 18 y, 2.27; 95% CI, 1.12-4.58); relatives being seen by a gastroenterologist (OR, 15.16; 95% CI, 7.72-29.80); relatives with symptoms (OR, 3.69; 95% CI, 2.11-6.47); first-degree relatives of a patient with celiac disease (OR, 4.90, 95% CI, 2.34-10.25); and relatives with a documented family history of celiac disease (OR, 11.9, 95% CI, 5.56-25.48). By using an algorithm to identify relatives of patients with celiac disease, we found that nearly 30% of symptomatic first-degree relatives of patients with celiac disease have not received the tests recommended by guidelines. Health care providers should implement strategies to identify and screen patients at increased risk for celiac disease, including methods to ensure adequate documentation of family medical history.

Disease Heritability Studies Harness the Healthcare System to Achieve Massive Scale

Heritability studies are essential for defining genetic influences on disease risk and trait variability. Polubriaginof etal. show how massive amounts of data contained in electronic health records can be used for heritability studies on hundreds of phenotypes. Mining emergency contact information with comparison to existing gold standards showcases the broad utility of the approach.

Surveillance for Mass Gatherings: NCAA Final Four 2017 in Maricopa County, Arizona

Objective: To describe and present results for the enhanced epidemiologic surveillance system established during the 2017 National Collegiate Athletic Association Division I Men’s College Basketball Championship (Final Four) events.Introduction: Final Four-associated events culminated in four days of intense activity from March 31st through April 3rd, and added an estimated 400,000 visitors to Maricopa County's 4.2 million residents.Methods: Preparation included: refinements in enhanced surveillance for previous events (including Super Bowl XLII); a rehearsal on information sharing for team leads; just in time training for field team members; a tabletop exercise on 2/22; and solicitation of lessons learned from jurisdictions recently hosting the Final Four.Enhanced surveillance began on 3/24 and continued through 4/10 (one week before the first major event until one week after the championship game) with intensified surveillance from 3/31-4/3. Subject matter experts for each enhanced surveillance component functioned as team leads. A surveillance coordinator was assigned to review data and prepare reports. Team members were sent a plan of the day detailing daily surveillance activities.An enhanced surveillance (SURV) alert requesting an increased index of suspicion for events of public health significance was sent to pre-established lists of healthcare providers. Urgent care clinics within five miles of venues were asked to report influenza-like, gastrointestinal, rash, and neurological illness visits daily. Emergency department records in the National Syndromic Surveillance Program, Electronic Surveillance System for Early Notification of Community-Bases Epidemics (ESSENCE) were monitored daily for influenza-like illness, gastrointestinal illness, injury, records of interest, heat-related illness and event-specific terms. Mumps and meningitis were added after outbreak reports were received from home jurisdictions of Final Four teams. Death certificate data, Office of the Medical Examiner line lists and preliminary reports of death were reviewed daily for reportable diseases or circumstances of public health significance. Communicable disease data was reviewed daily for notifiable disease cases of concern, aberration detection as compared to the previous four years, outbreak review, and Influenza-like-illness.Field teams of staff and volunteers were deployed to three days of Music Fest, four days of Fan Fest, and three Final Four games. Attendees presenting to first aid stations were requested to complete an electronic questionnaire capturing illness and injury syndromes. These were submitted and epidemiologically assessed in near-real-time. Syndrome-specific data were geo-located on venue maps during events to identify spatial clustering. Patient Presentation Rates (PPR) and Transport to Hospital Rates (TTHR) per 10,000 attendees were calculated.To enhance animal health system surveillance, veterinarians and agencies that work with animals were notified to increase the index of suspicion for unusual animal disease, keep alert for outbreaks with zoonotic potential, and update 24/7 emergency contact lists.Health-related media reports, Final-Four-specific reports, health-aggregated Twitter reports, and breaking news alert subscriptions were monitored. Poison Control Center (PCC) reports were assessed by conducting regular queries of the National Poison Data System (NPDS). Reports from the 24/7 Disease Reporting Line were monitored.A one page enhanced surveillance report was developed for daily distribution to inter-disciplinary partners; a more detailed report was distributed to health and medical partners. Physicians overseeing the health/medical care of teams were included in information sharing. Public health intelligence information was exchanged with epidemiologists from home jurisdictions of Final Four teams.Results: 301 field questionnaires were completed, including 146 from Final Four games, 127 from the Music Fest, and 28 from the Fan Fest. Final Four games experienced a PPR of 9.5, and a TTHR of 0.52. Music Fest results were a PPR of 9.4, and a TTHR of 0.15. For the Fan Fest, there was a PPR of 5.5, and a TTHR of 0.PCC data review resulted in investigation of four cases for potential ricin exposure. These reports were determined to be exposure to castor beans and the castor bean plant (Ricinus communis) only. One report indicating potential phosgene occupational exposure to an air conditioning system worker was reviewed, and judged unlikely to cause noted symptoms.Outbreak information from home jurisdictions of Final Four teams resulted in increased index of suspicion for mumps, additional surveillance and mentions in media surveillance reports.Review of communicable disease, mortality, and ESSENSE data resulted only in routine investigations.Conclusions: Surveillance information from disparate surveillance systems was synthesized into reports which enhanced health and medical situational awareness and information sharing; interdisciplinary partners highlighted the utility of the one-page report. Enhanced surveillance allowed the rapid identification and characterization of potential threats, and provided an evidence base for public health decisions. Establishment of field teams allowed for near-real-time tracking of patient presentations and transports and rapid identification and characterization of syndromes of concern and potential threats. Public health intelligence information exchange with home jurisdictions of Final Four teams resulted in targeted surveillance for mumps and meningitis.

Disease Heritability Inferred from Familial Relationships Reported in Medical Records

Heritability is essential for understanding the biological causes of disease but requires laborious patient recruitment and phenotype ascertainment. Electronic health records (EHRs) passively capture a wide range of clinically relevant data and provide a resource for studying the heritability of traits that are not typically accessible. EHRs contain next-of-kin information collected via patient emergency contact forms, but until now, these data have gone unused in research. We mined emergency contact data at three academic medical centers and identified 7.4 million familial relationships while maintaining patient privacy. Identified relationships were consistent with genetically derived relatedness. We used EHR data to compute heritability estimates for 500 disease phenotypes. Overall, estimates were consistent with the literature and between sites. Inconsistencies were indicative of limitations and opportunities unique to EHR research. These analyses provide a validation of the use of EHRs for genetics and disease research.

Intelligent vehicle black box using IoT

Millions of people die due to the accidents.The main purpose of this paper is to provide vehicle safety and a solution that automatically alert the driver to be cautious. In this paper we continuously monitor the vehicle performance using sensors and the behavior of driver with the use of IoT Technology.The Vehicle black box receives the information from various sensors like the breath analyzer, acceleration and the distance of surrounding vehicles along with push and panic button. When the driver alcohol consumption reaches maximum limit, the messages are sent to emergency contacts. If the accident occurs, by using GSM and GPS the vehicle location is traced and the information is sent to local hospital and police.With the IoT Technology, this location is always traced in the cloud platform service.The push and panic button is used to alert the 24/7 Governance to call out for emergency help.

Two-Wheeler Safety System for Accident Prevention, Detection and Reporting

The objective of this paper is to build a safety system which is integrated with the smart helmet and intelligent bike to reduce the probability of two-wheeler accidents and drunk and drive cases. The pressure sensor and the accelerometer sensor checks if the person is wearing the helmet or not. Alcohol sensors detects the alcoholic content in the rider’s breath. If the rider is not wearing the helmet or there is alcohol content found in rider’s breath, the bike remains off. The bike will not start until the rider wears the helmet and there is no alcoholic content present stating that rider did not consume alcohol. When the rider crashes, helmet hits the ground and sensors detect the motion and tilts of helmet and reports the occurrence of an accident and sends information of the location of accident to the family members of the rider and the emergency contact numbers.

Toward Optimizing Global Learning Opportunities for US Physical Therapy Students: A Description of Current Practices and Initial Recommendations

Purpose. To examine and describe the structure, curricular objectives, and outcome measurement practices of faculty developing and providing international opportunities in physical therapy education programs and to provide guidance and initial recommendations for faculty. Background. Physical therapy educational programs are adding international opportunities as a way to address the increasingly global nature of the profession. Guidelines to enhance practice, optimize the experience, and provide structure for managing risk are warranted. Methods. A researcher-developed survey was distributed to 216 physical therapy education programs and professional listservs. Respondents from 56 programs (26%) returned the survey. Data were analyzed descriptively. Results. Most respondents cited global understanding as critical to the physical therapy profession, and the reason for involving students in global learning opportunities. Knowledge of the host site, sustainability, and potential strength of partnership were cited as the most important factors when choosing an international community partner. Risk management efforts included supplemental insurance, availability of emergency contact information, safe transportation and housing plans, and plans for adverse occurrences. Conclusion. This study supplements previous literature in designing international student experiences. Activities addressing clear purposes and expected outcomes for all participants, including the community partner, and the university-community partnership before, during, and after the experience are essential.

Estimate of Disease Heritability Using 7.4 million Familial Relationships Inferred from Electronic Health Records

Heritability is essential for understanding the biological causes of disease, but requires laborious patient recruitment and phenotype ascertainment. Electronic health records (EHR) passively capture a wide range of clinically relevant data and provide a novel resource for studying the heritability of traits that are not typically accessible. EHRs contain next-of-kin information collected via patient emergency contact forms, but until now, these data have gone unused in research. We mined emergency contact data at three academic medical centers and identified millions of familial relationships while maintaining patient privacy. Identified relationships were consistent with genetically-derived relatedness. We used EHR data to compute heritability estimates for 500 disease phenotypes. Overall, estimates were consistent with literature and between sites. Inconsistencies were indicative of limitations and opportunities unique to EHR research. These analyses provide a novel validation of the use of EHRs for genetics and disease research.

Neonatal Diabetes: Nurse Navigator Role

Neonatal Diabetes: Nurse Navigator Role

Emergency information management needs and practices of older adults: A descriptive study

ObjectiveTo better understand how older adults currently manage emergency information, the barriers and facilitators to planning and management of emergency information, as well as the potential role of information technology to facilitate emergency planning and management. IntroductionOlder adults face a much higher risk of sudden illness/injury and are the age group with the largest percentages of emergent and urgent healthcare visits. Emergency information (health information needed in an emergency situation such as emergency contact information, diagnoses, and advance directives) needs to be maintained and easily accessible to ensure older adults get appropriate care and treatment consistent with their wishes in emergency situations. Current health information technologies rarely take into consideration the emergency information needs of older adults, their caregivers, and emergency responders. MethodsAs part of a larger study we performed in-depth interviews with 90 older adults living in a variety of residential settings (independent living, retirement communities, assisted living) regarding how they manage information about their health. Interview sessions included photos of important health information artifacts. Interviews were transcribed and coded. ResultsAnalysis of in-depth interviews revealed that emergency information is a type of health information that older adults frequently manage. Participants differed in whether they practice emergency planning (e.g. the preparation and continued management of emergency information), and in whether they involve others in emergency information and emergency planning. Despite its importance, emergency information was often not up-to-date and not always kept in locations readily apparent to emergency responders. ConclusionEmergency information, such as emergency contact information, diagnoses, and advance directives, is a type of health information that older adults manage. Considering emergency information in the design of health information technologies for older adults could address some of the barriers and support the facilitators to emergency planning and information management.

The Oncology Family App: Providing Information and Support for Families Caring for Their Child With Cancer.

The Oncology Family App supports families across the vast state of Queensland, Australia, with easy access to vital information, including management plans for a deteriorating child, patient specific information and other resources. This article describes the development and evaluation of this mobile app. The app was developed and tested in collaboration with parents, caregivers, and clinicians and released in November 2015. This first version featured "Statewide Hospital Contacts," including phone numbers, links to Google maps, and 24-hour emergency contacts with click to call functionality; "When to Call" describing symptoms to look out for in a deteriorating child; "Blood Results Table"; and "Information" listing recommended websites, health care team contacts, appointments, and notes. The app was evaluated through interviews with parents, caregivers and patients and download metrics. Six months after the app release, 68% of the 38 parents and caregivers surveyed had downloaded the app. The most used modules were "Blood Results Table," "When to Call," and "Statewide Hospital Contacts," but families reported using all features available. Families were enthusiastic about the support the app provided and gave useful feedback to direct future development. Using mobile health technology to support families is a novel, but rapidly growing concept. Family and caregiver feedback showed that the Oncology Family App was an efficient and convenient way to provide much needed information. A new version of the app is under development and evaluation of outcomes will be ongoing.

Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak.

After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.

A Scoping Review of Economic Evaluations Alongside Randomised Controlled Trials of Home Monitoring in Chronic Disease Management.

Many countries have considered telemedicine and home monitoring of patients as a solution to the demographic challenges that health-care systems face. However, reviews of economic evaluations of telemedicine have identified methodological problems in many studies as they do not comply with guidelines. The aim of this study was to examine economic evaluations alongside randomised controlled trials of home monitoring in chronic disease management and hereby to explore the resources included in the programme costs, the types of health-care utilisation that change as a result of home monitoring and discuss the value of economic evaluation alongside randomised controlled trials of home monitoring on the basis of the studies identified. A scoping review of economic evaluations of home monitoring of patients with chronic disease based on randomised controlled trials and including information on the programme costs and the costs of equipment was carried out based on a Medline (PubMed) search. Nine studies met the inclusion criteria. All studies include both costs of equipment and use of staff, but there is large variation in the types of equipment and types of tasks for the staff included in the costs. Equipment costs constituted 16-73% of the total programme costs. In six of the nine studies, home monitoring resulted in a reduction in primary care or emergency contacts. However, in total, home monitoring resulted in increased average costs per patient in six studies and reduced costs in three of the nine studies. The review is limited by the small number of studies found and the restriction to randomised controlled trials, which can be problematic in this area due to lack of blinding of patients and healthcare professionals and the difficulty of implementing organisational changes in hospital departments for the limited period of a trial. Furthermore, our results may be based on assessments of older telemedicine interventions.

Improving the Safety and Functionality of an Artificial Pancreas System for Use in Younger Children: Input from Parents and Physicians.

Artificial pancreas (AP) systems have initially been designed for and tested in teens and adults, but there is evidence that an AP system with additional support and safety systems could greatly benefit younger children with type 1 diabetes (T1D). Five pediatric endocrinologists and 15 parents of children aged 5-8 years with T1D participated in a total of four focus groups. Focus groups investigated current diabetes technology use and acceptance, as well as possible modifications to the current adult AP system, which would allow for safe and successful use in younger children. Modifications discussed include child-specific functionality for input tasks, safety features, and monitoring capabilities. Participant suggestions included the following: passcodes for differential access to AP features by parents, ancillary caregivers, and the child; preset early, intermediate, and advanced child access categories; maximal customization for general and alarm settings; simplified meal screens utilizing the AP' corrective blood glucose (BG) ability; automated exercise mode; spoken and dictated messaging capabilities; emergency contacts; treatment instructions for the child and caregiver; remote monitoring website and application; animated continuous glucose monitor BG trace; gamification, such as rewarding diabetes-friendly behaviors; and comprehensive training of all individuals involved in the child's diabetes care. Parents and physicians were eager for AP applications to be available for younger children, but stressed that a modified system could better serve this group's needs for safety and improved diabetes-related communication. The diverse and emerging needs of 5-8-year olds require flexible and customizable systems for T1D management.

Discrepancy between information provided and information required by emergency physicians for long-term care patients.

The primary objective of this study was to identify information included in long-term care (LTC) transfer documentation and to compare it to the information required by local emergency department (ED) physicians to provide optimal care and make decisions for LTC patients. A retrospective chart review was conducted for a sample of LTC residents transferred by ambulance to the ED of an academic, tertiary care hospital over a 1-year period. All emergency physicians working at the institution were invited to complete an online questionnaire about information included in LTC transfer documentation and information required by emergency physicians to provide care for LTC patients. Of the 200 charts reviewed, the most common information transferred to the ED with the LTC patient was the patient's past medical history (n=184, 92.0%), name of family physician (n=182, 91.0%), a list of known allergies (n=179, 89.5%), the reason for transfer to the ED (n=155, 77.5%), the patient's emergency contact information (n=152, 76.0%), and medication administration record (n=150, 75.0%). From a physician's perspective, the most frequently requested pieces of information included reason for transfer, past medical history, cognitive status, advanced directives for level of care and resuscitation, and the patient's emergency contact information. This information was provided 77.5% (n=155), 92.0% (n=184), 24.0% (n=48), 62.0% (n=124), and 76.0% (n=152) of the time, respectively. Our study demonstrates a clear discrepancy between information provided and information required by emergency physicians for LTC patients. Quality improvement initiatives at the local level may help reduce this discrepancy.

Be ready for emergencies with a local contact data tool

MINNEAPOLIS — How do you contact students in case of emergency? Do you have accurate and current data on student local contact information, in case you can't locate them on campus? At the annual conference of the American Association of Collegiate Registrars and Admissions Officers, Jeff Armstrong, assistant registrar and administrative program specialist; Jeremy Traska, assistant registrar; and Keri Allard, assistant registrar, all from the University of Wisconsin at Madison, shared their experiences and best practices in putting together their student local and emergency contact information and the Emergency Response Data Tool, in conjunction with their campus security office.

Be ready for emergencies with a local contact data tool

MINNEAPOLIS — How do you contact students in case of emergency? Who has access to your emergency contact list? Do you have accurate and current data on students' local contact information, in case you can't locate them on campus? At the annual conference for the American Association of Collegiate Registrars and Admissions Officers, Jeff Armstrong, assistant registrar and administrative program specialist; Jeremy Traska, assistant registrar; and Keri Allard, assistant registrar, all from the University of Wisconsin at Madison, shared their experiences and best practices in putting together their student local and emergency contact information and the Emergency Response Data Tool, in conjunction with their campus security office.

BJP ASM Poster Abstracts 2017

Background There is a lack of research available that examines the diverse population of frequent users of Urgent and Emergency Healthcare services throughout England. The motivations and decision-making processes which frequent users take into consideration when selecting episodic treatment from: Out of Hours GPs; NHS111; Ambulance Services and Emergency Departments are not full examined. Most research explores this population by focusing on the patient’s demographics or preliminary diagnosis, rather than their unmet needs that has instigated the urgent and emergency contact. Subjective terminology and arbitrary thresholds are employed across these services to identify these individuals, with little standardisation or clinical justification to the reasons why they have been selected. Through understanding the unmet needs of this heterogenous population, improved individualised patient centred support and management options should be achieved. Aims The aim was to analyse the underlying reasons why frequent users of Urgent and Emergency Healthcare Services in England, select and request episodic instances of care, rather than the consistent approach provided within primary care. Methods A systematic mapping exercise was undertaken to create a comprehensive understanding of how these services are currently working with regard to frequent users. The search produced 5094 articles which were screened against the inclusion criteria, leaving 156 articles to be analysed. Data was extracted and a thematic synthesis was used to analyse this diverse population. From this analysis, a taxonomy of sub-groups of frequent users was formed and their underlying needs identified. Thirty-two clinical semi-structured interviews throughout these services were undertaken, to gain critical feedback on the robustness and viability of the taxonomy. A purposeful sampling method ensured that clinical practitioners that had substantial experience in supporting and managing these complex and vulnerable individuals participated within the research. The qualitative data received from clinicians with knowledge and skills of working with this population prompted adjustments to the original taxonomy. Results The taxonomy sub-divided the main heterogeneous group into 5 main groups: Elderly and Frail; Mental Health; Substance Misuse; Chronic Conditions; and Homeless and Vulnerably Housed. Within each sub-group, unmet needs were identified and further categorised. A hidden population of patients that were accessing urgent and emergency healthcare services due to unresolved pain emerged. This population was categorised into: persistent or chronic pain; acute episodes of severe pain (crisis) and addiction, opioid-induced hyperalgesia or tolerance factors. The reasons attributed to the patients’ frequent contacts were due to the breakdown of their relationship with their GP, polypharmacy issues, access to primary care treatments, perceptions and judgements from clinicians and lack of adequate clinical training around pain management both in primary and acute settings. These high intensity users of urgent and emergency healthcare services are often the most vulnerable and complex members of our society. Conclusion Repeated episodic instances of care, which are often given in urgent and emergency healthcare settings relating to pain management are not proactively allowing individuals to manage their long-term outcomes. Understanding the patients’ unmet needs and what has instigated their frequent contacts to services, could enable clinicians to signpost into other specialised services which will improve the patients’ quality of care. Furthermore, Improved pain management training in both the primary and acute services relating to high intensity users could diminish the negative experiences faced by these individuals and frustrations felt within day to day practice.