Abstract
Introduction: Analysis of high-intensity users of the Emergency Department (ED) to identify priority patient cohorts for a new holistic care coordination service co-designed with relevant stakeholders.
Target community: High-intensity users of the ED who need support to optimise their health and wellbeing and reduce dependence on the acute healthcare system.
Stakeholder involvement: A multi-agency comprehensive report outlining the issues faced by consumers with complex healthcare needs, the requirement for a navigation service, and a proposed service model published by the Health Care Consumers’ Association of the ACT (HCCA) is the foundational platform for our current service initiative. Canberra Health Services has undertaken an analysis of high-intensity users of ED, identified priority patient cohorts and, in collaboration with HCCA, engaged community organisations relevant to the priority cohorts to co-design a new liaison and navigation service.
Method: De-identified data for patients with ten or more presentations to the ED in a twelve-month period was extracted from the ED patient administration system. Patient demographic analysis was undertaken along with case reviews of medical history and patient journey. The analysis identified priority patient cohorts in need of support to better manage their health. To ensure engagement in the process of co-design and capture a broad range of perspectives efficiently, HCCA and CHS arranged workshops and stakeholder meetings with organisations and services working with the identified priority patient cohorts to co-design a service to meet patient needs.
Findings: Amongst the 155 patients who presented to ED ten or more times in the twelve-month period, the average age was forty-two with a higher proportion of female patients (60%) and Aboriginal and Torres Strait Islander patients (11%). A high proportion of the ED presentations were for mental health conditions (20%) and case review frequently revealed the influence of mental health in presentations that were, on the surface, for physical health conditions. Workshops with relevant community organisations reaffirmed that the patients themselves would be unlikely to engage with the health service – the key theme that emerged was the need to ‘rebuild trust in the health system’. Other themes included the need for a high level of initial support to develop health literacy and empower self-management, and the need to address the social determinants of health. The high-intensity users of ED had many scheduled outpatient appointments with a high rate of non-attendance, suggestive of a fragmented referral approach with a lack of holistic assessment, planning and care coordination.
Key learning: High-intensity users of the ED have complex needs and vulnerabilities that are not being met by standard health referral pathways. These patients therefore require targeted, patient-centred, and holistic care coordination inclusive of health, social and emotional needs.
Next steps: A new liaison and navigation service will be established, primarily targeting (a) people with a mental health diagnosis and two or more physical health conditions, and (b) high-intensity users of emergency departments.