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SHarED: Supporting high impact users to Emergency Departments

The project, which aims to improve outcomes for the most frequent users of Emergency Departments and reduce their attendance rates, was developed at University Hospitals Bristol (UHB).  This initiative has been running there for five years and has had great success in reducing attendances to the Emergency Department (ED) as well as supporting users to seek healthcare and support in a more appropriate way.

SHarED (Supporting High impact users to Emergency Departments) was put forward fo the West Of England AHSN’s 2019 Evidence into Practice Challenge by Dr Becky Thorpe of UHB. It was one of two programmes selected as adoption and spread projects across the West of England. The West of England AHSN are now working collaboratively with the team to spread SHarED to other Emergency Departments across the local area. A Project Steering Board has been created and all acute Trusts in the region are invited to join this improvement work

Why is SHarED necessary?

High impact users (HIU) of EDs suffer some of the most severe health inequalities in the UK.  HIU and ‘super-users’ are defined as those who attend the ED more than 5 times and 20 times respectively. They experience exceptionally high rates of mental health problems, learning disability, homelessness, substance misuse, domestic abuse, safeguarding concerns and are often from an ethnic minority background. They often attend the ED as they have nowhere else to go.

There is also a significant financial impact on the NHS, with some ‘super-users’ costing £30,000 per year in ED attendance and hospital admission alone.

How does SHarED work?

The SHarED project aims to provide complete parity of esteem for all patients in the ED through delivery of the personal support plans. The plans are co-created by HIU co-ordinators and other relevant professionals from the multidisciplinary team.  The team work with 10 HIUs at any one time with new individuals being selected through a locally developed triaging tool.

The SHarED team from University Hosptial Bristol:


What are the benefits of SHarED?

Through the multiagency case management approach significant improvements have been recored for both the ED and patients:

  • 80% reduction in super-user ED attendances
  • 30% reduction in all patients with mental health problem
  • Improved patient experience
  • Improved staff experiences
  • Financial savings from attendance and admission tariffs associated with the service are £900k per year