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A PILOT PROJECT TARGETING FREQUENT ATTENDERS AT THE EMERGENCY DEPARTMENT WITH MEDICALLY UNEXPLAINED SYMPTOMS
Abstract
Objectives & Background: We identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved. Methods: Each month we looked at attendance data for the previous 3 months (this identified people who in an acute phase of repeat presentations). By accessing patients clinical records we determined the main factors which appeared to drive their frequent attendance and admissions and identified those who presented with MUS. Care plans were developed and each patient was contacted and offered weekly Cognitive Behavioural Therapy (CBT) sessions to help them manage their symptoms. This was part of a case management approach in which coordinated, multidisciplinary reviews were undertaken resulting in an individualised care plan. Results: Thus far the pilot has seen a reduction in attendances at ED for 100% of patients included in study (N=20). Crucially, all now attend less than once per month. In total 245 attends were saved after the CBT interventions Conclusion: Providing a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs.
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“Further, the efficacy of CBT for FAs has been studied with promising results [13–15].”
From One-session cognitive behavior treatment for long-term frequent attenders in primary care: randomized controlled trial (2019) · cites this paper as [14]
Citations
Cited by
Moe, J., Kirkland, S. W., Rawe, E., Ospina, M. B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017) · Academic Emergency Medicine · doi:10.1111/acem.13060 · Cited by 218
Korczak, V., Shanthosh, J., Jan, S., Dinh, M. M. Q., & Lung, T. W.-C. (2019) · BMC Emergency Medicine · doi:10.1186/s12873-019-0296-4 · Cited by 35
Taha, S. H. N., Zaghloul, H. S., Ali, A. A., Gaballah, I. F., Rashed, L. A., & Aboulhoda, B. E. (2020) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-020-01875-5 · Cited by 29
Malins, S., Kai, J., Atha, C., Avery, A., Guo, B., James, M., Patel, S., Sampson, C., Stubley, M., & Morriss, R. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x686569 · Cited by 23
Better safe than sorry? Frequent attendance in a hospital emergency department: an exploratory study
Daniels, J., Osborn, M., & Davis, C. (2017) · British Journal of Pain · doi:10.1177/2049463717720635 · Cited by 22
Casey, M., Perera, D., Enticott, J., Vo, H., Cubra, S., Gravell, A., Waerea, M., & Habib, G. (2021) · International journal of psychiatry in clinical practice · doi:10.1080/13651501.2021.1904998 · Cited by 15
“It has been identified that high utilisers with mental health issues are a group most in need of long-term therapeutic support (Australasian College of Emergency Medicine 2019) and can benefit from psychological intervention (Baker et al. 2013; Daniels et al. 2018).”
BackgroundTaha, S. H. N., Zaghloul, H. S., Ali, A. A., Rashed, L. A., Sabry, R. M., & Gaballah, I. F. (2020) · Molecular Biology Reports · doi:10.1007/s11033-020-05894-6 · Cited by 15
Psychiatric Case Management in the Emergency Department
Turner, S. B., & Stanton, M. P. (2015) · Professional Case Management · doi:10.1097/ncm.0000000000000106 · Cited by 14
The effect of integrated care on self-management and emergency department attendance
Scheiner, N., Cohen, S., Davis, R., et al. (2019) · BJPsych Bulletin · doi:10.1192/bjb.2019.1 · Cited by 6
Luutonen, S., Santalahti, A., Mäkinen, M., Vahlberg, T., & Rautava, P. (2019) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2019.1569371 · Cited by 4
“been studied in patients with somatoform disorder or medically unexplained symptoms [11,12] or FAs with medically unexplained symptoms [13,14].”
BackgroundBooth, A., Preston, L., Baxter, S. K., Wong, R., Chambers, D., & Turner, J. (2019) · Health Services and Delivery Research · doi:10.3310/hsdr07330 · Cited by 3
Rozenfeld, M., Peleg, K., Givon, A., et al. (2017) · Injury · doi:10.1016/j.injury.2017.04.059 · Cited by 2
Lennox, G. A. K., & Kendall, R. (2019) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000000613 · Cited by 1
“related visits Baker et al. (2013) [11] CBT + individual care plan MUS, n = 20 ED presentations (6 mo) Reduced visits from 16.”
BackgroundInfluentialFunktionelle Symptome und somatoforme Störungen in der Notaufnahme
Dinkel, A., & Lahmann, C. (2016) · Notfall + Rettungsmedizin · doi:10.1007/s10049-016-0136-y
Casey, M. F., Perera, D. N., Vo, H., Silva, L. D., & Clarke, D. M. (2025) · Healthcare · doi:10.3390/healthcare13192391
“It has been documented that high ED utilizers with mental health issues are most in need of long-term therapeutic support [26] and can benefit from psychological intervention [4,27,28].”
Metadata
- Authors
- Baker, M., Stallard, J., & Gibson, S.
- Affiliations
- Royal Bournemouth Hospital (GB)
- Venue
- Emergency Medicine Journal
- Publisher
- BMJ
- Published
- 2013-09-07
- Volume
- 30
- Issue
- 10
- Pages
- 866.2-866
- ISSN
- 1351-0622 (ISSN-L)
- 1472-0205
- 1472-0213
- OpenAlex
- W2332999596
- Cited by
- 15
- References
- 0
- Citations by year
- 2025: 1 · 2021: 1 · 2020: 2 · 2019: 5 · 2017: 3 · 2016: 2 · 2015: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Emergency Medicine Journal (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- frequent attenders, emergency department visits, medically unexplained symptoms, cognitive behavioral therapy, case management, care planning, multidisciplinary care, hospital resource utilization, cost containment, psychological intervention, frequent hospital admissions
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