The SHarED (Supporting High impact users in Emergency Departments) project aimed to improve outcomes for the most frequent users of Emergency Departments (EDs). The model was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years. The UHBW project has had great success in reducing attendances to the Emergency Department (ED), whilst supporting users to seek healthcare and support in a more appropriate way.
Celebrating SHarED – a positive impact on patients and staff:
As the SHarED project came to a close the collaborative celebrated some interim results:
- 140 HIU have been engaged across the five adopting EDs;
- with over 360 staff being trained to support HIUs and
- a 44% reduction in the number of attendances following the first month of engagement for 89% of the patients engaged.
How did SHarED start?
In 2019, Dr Becky Thorpe of UHBW put forward SHarED for our Evidence into Practice Challenge. Read more about the Evidence into Practice challenge. It was one of two programmes selected for adoption and spread across the West of England. We worked collaboratively with the team to spread SHarED to all five EDs in the region. There was an active Project Steering Board and all acute Trusts in the region have been involved in this improvement work.
Watch our introduction to SHarED video below or view our introduction to SHarED on vimeo.
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 five 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. 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. View the resources for implementation of SHarED.
Hear more about SHarED and how the model can reduce readmission rates in high impact users, in this short video:
Find out more about SHarED by reading a blog ‘High impact users – changing the culture’ from Sally Buckland, High Impact Unit Team Lead, Bristol Royal Infirmary.
What are the benefits of SHarED?
Through the multi-agency case management approach, significant improvements have been recorded for both the ED and patients:
- Improved patient experience
- Improved staff experiences
- Collaborative working between multi disciplinary teams
- Financial savings from attendance and admission tariffs associated with the service.
Find out more about the benefits of the project in our SHarED impact case study.
What’s next?
Whilst AHSN funding came to an end in late 2021, all ED teams are now in the process of developing their business cases for ongoing funding. If teams are successful, the West of England Academic Health Science Network will look to continue to support the teams as they transition in to a self-sustaining High Impact User Community of Practice; enabling shared learning and providing an opportunity to discuss complex or joint cases.
We look forward to the final results of the evaluation, being completed by ARC West, which are anticipated to be complete in early 2023.
