As the Supporting High impAct useRs in Emergency Departments (SHarED) project comes to a close the collaborative are celebrating the interim results for patients and staff. The project aimed to pilot a High Impact User (HIU) service in each Emergency Department (ED) in the West of England in order to better manage and support a cohort of patients that frequently attend EDs. Before being chosen for regional adoption and spread as one of two successful 2019 Evidence in to Practice applications, a HIU model was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years.
Why is supporting HIUs so important?
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 and 20 times respectively each year. As a patient group, HIUs experience exceptionally high rates of mental health challenges; learning disability; homelessness; substance misuse; domestic abuse and safeguarding concerns. HIUs often attend the ED as they have nowhere else to go.
As well as the negative outcomes for HIUs attending ED when that service may be unsuitable for their needs, and the resulting strain on ED staff to manage high levels of repeat attendances, there is also a significant financial impact on the NHS. Some ‘super-users’ cost £30,000 per year in ED attendance and hospital admission.
The impact on patients
Whilst working on a new project during the COVID-19 pandemic offered a series of challenges, collectively the five ED teams across the West of England have supported over 140 patients.
Interim data demonstrates:
- a 44% reduction in the number of attendances following the first month of engagement for 89% of the patients engaged.
- The remaining 11% of the patients saw a significant escalation in their behaviour, however it is broadly acknowledged that the highly complex nature of these individuals often means that where attendances cannot be reduced, the teams are there to provide appropriate support and improve the experience of the patients and staff members alike.
- Additional data collected by a number of trusts demonstrates that where attendance had increased, the impact and cost of each attendance had reduced.
Dr Rebecca Thorpe, the Clinical Lead for SHarED said:
The SHarED project has propelled our work to support some of the most vulnerable, marginalised patient groups in society, who access Emergency Departments frequently, for a variety of reasons. Working with teams from Emergency Departments all over the West of England, we’ve educated staff and supported patients to work towards safer patient care and an improved experience for patients and staff. It’s a fantastic example of cultural change across the whole patch.
Clare Evans, the Programme Manager for SHarED said:
The West of England AHSN are proud to have supported the adoption and spread of the HIU model across our region. The project has flourished despite the challenges presented by the pandemic and that is a testament to the dedication and hard work of everybody involved – especially the staff in ED teams. The commitment to appropriately supporting this most vulnerable of patient groups has been exemplary.
The impact on ED staff
Throughout the funded period of the project, the ED teams have delivered training to over 360 members of staff to raise awareness of the service and best practice guidance on how to manage HIUs, ultimately seeking to improve the culture in the department.
Feedback from a recent staff experience survey included:
- “Dedicated HIU teams are making a real difference to the appropriate management of these patients.”
- “Great to have agreed (HIU) plans that are regularly reviewed with opportunity for patient input.”
- “Our HIU team are brilliant and have made a huge impact on not only the number of attendances but patient outcome and reduction in violence and aggression cases”
- “The (HIU) support plans in place currently are really helpful. Keep it up!”
Dr Sarah Harper, Pain Consultant and HIU Team Lead, Gloucestershire Hospitals NHS Foundation Trust said:
Taking part in SHarED allowed our HIU Team the time, support and resource to really address the underlying issues which can drive patient requirement for large amounts of unscheduled care. By developing Personal Support Plans, in collaboration with patients and other professionals, we managed to reduce attendance rates, reduce admission rates to hospital and smooth the path of patients when they did attend the Department, thereby supporting our staff in dealing with these patients who often have complex health needs. Feedback from our ED staff was extremely positive. Looking to the future, with thanks to SHarED, we’re continuing to develop our HIU service.
While the West of England AHSN funding has now ceased, the ED teams are working with their trusts to secure on going support. Each team are passionate about continuing the important work that has been started in the SHarED project.
We are now looking forward to the seeing the full project evaluation, which will seek to fully understand the effectiveness of the SHarED model. We expect to receive the completed evaluation in Autumn 2022.
Read more about the SHarED project. Our free resources include an implementation guide to support trusts and systems outside the West of England to review, adopt and spread the model.