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SHarED: Supporting high impact users in Emergency Departments

The SHarED project aims to improve outcomes for the most frequent users of Emergency Departments (EDs) and reduce their attendance rates. It was developed at University Hospitals Bristol (UHB), where it has been running for five years. The project 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.

In 2019, Dr Becky Thorpe of UHB put forward SHarED (Supporting High impact users in Emergency Departments) for our Evidence into Practice Challenge. It was one of two programmes selected for adoption and spread across the West of England. We are now working collaboratively with the team to spread SHarED to other Emergency Departments in 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 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.

The SHarED team from University Hosptial Bristol:

What are the benefits?

Through the multi-agency case management approach, significant improvements have been recorded 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.

Explore the SHarED Implementation Guide and resources

SHarED Implementation Guide

Resources for implementing SHarED

These resources support the implementation of a High Impact User Team and give advice and guidance on achieving successful SHarED implementation in your emergency department.

View the resources