title: Frequent users of the emergency department: a program to improve care and reduce visits.
abstract: The authors describe a case-management program for frequent users of the emergency department. The study had a single-subject design, with evaluation for each patient of the number of visits to the emergency department for a 12-month period before referral to the program and a similar period after implementation of an individualized care plan. Referrals were made on the basis of 2 or more of the following criteria: chronic medical condition, complex medical condition, drug-seeking behaviour, violent behaviour and abusive behaviour. A multidisciplinary team developed the individualized care plans. Twenty-four patients agreed to participate. For the 12-month period before their referral, these patients accounted for a total of 616 (median 26.5) visits to the emergency department; for a similar period after implementation of the care plans, they accounted for 175 (median 6.5) visits. The difficult-case management program appeared to be effective in reducing the total number of visits to the emergency department during the study period and in improving the care for these patients.
authors.affiliation: Emergency Department, St. Paul's Hospital, Vancouver, BC.
authors.forename: D
authors.initials: D
authors.lastname: Pope
authors.forename: C M
authors.initials: CM
authors.lastname: Fernandes
authors.forename: F
authors.initials: F
authors.lastname: Bouthillette
authors.forename: J
authors.initials: J
authors.lastname: Etherington
mesh_terms: D000328:Adult; D000368:Aged; D019090:Case Management; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012017:Referral and Consultation; D019966:Substance-Related Disorders