title: Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.
abstract: Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p<0.001) but not with gender (p>0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate.
authors.affiliation: Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK Rebecca.Jacob@cpft.nhs.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jacob
authors.affiliation: Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Mai Luen
authors.initials: ML
authors.lastname: Wong
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hayhurst
authors.affiliation: MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Watson
authors.affiliation: Engineering Design Centre, University of Cambridge, Cambridge, UK.
authors.forename: Cecily
authors.initials: C
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010361:Patients / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Frequent attenders; MUS; medically unexplained symptoms; service design