Interventions To Decrease Frequent ED Use May Be Effective But Best Strategies Not Clear Interview with:
Jessica Moe MD, MA, PGY5 FRCPC
Emergency Medicine, University of Alberta
MSc (Candidate) Clinical Epidemiology What is the background for this study? What are the main findings?

Response: Frequent visitors are common in many urban emergency departments (ED). They represent high resource-utilizing patients; additionally, existing literature demonstrates that they experience higher mortality and adverse health outcomes than non-frequent ED users. Interventions targeting frequent ED users therefore may potentially prevent adverse outcomes in this high risk patient group. The purpose of this study was to provide an up-to-date review of the existing literature on the effectiveness of interventions for adult frequent ED users.

This systematic review summarizes evidence from 31 interventional studies. The majority evaluated case management and care plans; a smaller number of studies examined diversion strategies, printout case notes, and social work visits. Overall, the studies were considered to have moderate to high risk of bias; however, 84% of before-after studies found that ED visits significantly decreased after the intervention. Additionally, studies examining interventions for homelessness consistently found that interventions improved stable housing. Overall, effects on hospital admissions and outpatient visits were unclear.

In summary, the available evidence is encouraging and suggests interventions targeted towards frequent ED users may be effective in decreasing ED visit frequency and improving housing stability. What should readers take away from your report?

Response: Clinicians and policy makers should recognize that frequent ED users are a high risk patient group, and should feel empowered that targeting interventions towards them may have a demonstrable positive impact. The most effective interventions appear to be multi-faceted, and the essential components of the strategy are not clear from this literature review. Clinicians and policy makers may play key leadership roles in identifying, developing and implementing locally relevant interventions for the frequent ED user populations in their specific regions or institutions. What recommendations do you have for future research as a result of this study?

Response: Future research should focus on comparative effectiveness research to identify the essential components that maximize effectiveness of interventions. In addition, research is required to comprehensively evaluate cost-effectiveness of interventions for frequent ED users. Finally, studies should focus on employing standardized definitions of frequent ED use, improving the methodological rigor (e.g., trial registration, reducing risk of bias, reporting on intervention fidelity and costs, and using higher quality study designs), and comprehensively reporting important patient outcomes (e.g., ED visits, hospitalization and death). Is there anything else you would like to add?

Response: ED clinicians and policy-makers are in a unique position to identify high risk patients for poor outcomes (e.g., poor, indigenous, homeless, frequent visitors, etc.) and to improve the outcomes for these patients by applying selective, targeted interventions. This systematic review demonstrates the important impact that ED practitioners may have by identifying, advocating for, and contributing to ongoing research concerning frequent ED users. Thank you for your contribution to the community.

Provider: John Wiley & Sons, Ltd Content:text/plain; charset=”UTF-8″ TY – JOUR AU – Moe, Jessica AU – Kirkland, Scott AU – Rawe, Erin AU – Ospina, Maria B AU – Vandermeer, Ben AU – Campbell, Sandy AU – Rowe, Brian TI – Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A systematic review JO – Academic Emergency Medicine JA – Acad Emerg Med SN – 1553-2712 UR – DO – 10.1111/acem.13060 SP – n/a EP – n/a PY – 2016 ER –

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 9, 2016 by Marie Benz MD FAAD