Mapping Current Services for Frequent Users of the Emergency Department in England

Abstract Background Frequent attendance at emergency departments (EDs) is a growing concern in the United Kingdom (UK), with about 2.5% of visitors accounting for approximately 10% of all ED attendances, leading to significant healthcare costs. Frequent users often face complex health issues, including high rates of multimorbidity. Despite various interventions aimed at reducing these visits, evidence from randomized controlled trials remains limited. The aim of this study was to better characterise current services in England for frequent users of the emergency department.Methods A regular national survey of liaison psychiatry services attached to all 171 acute hospitals in England was used to identify local frequent user services. The survey included questions about the existence and details of frequent user services at each hospital. Following data collection, the team categorized responses and selected 20 representative services for in-depth study, interviewing clinicians using a framework designed to describe healthcare organizations, focusing on capacity, organizational structure, financial mechanisms, patient characteristics, and care processes. Results: The survey had a 100% response. 157 acute hospitals (92%) were served by some form of service for frequent users. 81 hospitals (48%) reported frequent user services with dedicated staff time, 76 hospitals (44%) operated case management meetings but without designated staff, 14 hospitals reported no services for frequent users. Interviews conducted with 20 sites highlighted great variability amongst services on nearly all parameters including staffing levels, entry criteria, caseload, types of intervention and funding. Community-led services typically employed more staff and offered holistic, non-clinical social interventions compared to hospital-based services, which were more focused on case management meetings and psychological support/interventions.Conclusions The study revealed significant heterogeneity in services for frequent users of emergency departments. There is a need for clarity on intervention thresholds, types of interventions, and effective methods for evaluating outcomes to improve the consistency and effectiveness of these services to guide decision-making.