Skip to content

SHarED: Supporting high impact users in Emergency Departments

The SHarED (Supporting High impact users in Emergency Departments) project aimed to improve outcomes for the most frequent users of Emergency Departments (EDs). It was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years. The 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 interim results:

As the AHSN’s funding for the SHarED project starts to come to an end in summer 2021, following the official launch in August 2020, a second workshop was held in April 2021. All ED teams in the West of England region were given the opportunity to present on their excellent progress in setting up and/or improving their High Impact User (HIU) Service in their EDs.

Interim results noted 127 HIU have been engaged so far across the five adopting EDs, with over 200 staff being trained to support HIUs.

Read more in our news article which celebrates the interim successes of SHarED.

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 have been working collaboratively with the team to spread SHarED to all five EDs in the region. There’s an active Project Steering Board and all acute Trusts in the region are 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.

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:

  • 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.

2021 will see the completion of the SHarED project. We look forward to working together as a network of High Impact User Teams across the West of England to continue to support our patients and clinicians and change and improve the culture around HIU.

What’s next?

With AHSN funding coming to an end in summer 2021, all 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.

A final workshop will be held in the summer of 2021 to celebrate all that has been achieved; we’ll also look forward to the final results of the evaluation, which are anticipated to be complete in autumn 2022.

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