Streamlining access to community care for patients with complex care needs who attend the ED frequently

This project will streamline access to more efficient and structured health care and wrap-around support services through case management to a highly disadvantaged patient group with complex care needs who attend the ED frequently.

The benefits of case management to support people who attend frequently is well established (Moss et al, 2002; Sadowski et al, 2009; Quilty et al, 2019) and a program developed in Katherine (NT) demonstrated improved patient outcomes and cost effectiveness in terms of reducing ED attendance and increasing care within community (Quilty et al, 2019).

This project aims to deliver patient-centred care to a complex cohort through intensive case management by a clinical nurse co-ordinator working across the ED-Alcohol and Other Drugs (AOD) interface to facilitate primary care links, AOD support, hospital outpatient appointments and wrap around services to improve health outcomes for this patient cohort who use ED frequently.
RDH and Palmerston Hospital ED receives 86,600 annual presentations. As part of the Alcohol Harm Minimisation Project (NT Government, 2018), screening of presentations found 17% screen positive to alcohol consumption. Alarmingly, of those screening positive, 24% report consuming 11 or more standard drinks on a typical day. Reviews of very frequent attenders within this database reveal fragmented care with recurring themes of clusters of re-attendance for the same medical concern that has escalated, repeat attendances for the same medical problem exacerbated by alcohol consumption, and repeat attendance as victims of assaults and domestic and family violence.

Furthermore, patients attending the ED with police (when there is a medical concern deeming them unsafe to be cared for at the police Watch House or sobering up shelter) are commonplace, with 247 attendances over three months by 170 patients. And patients re-attended frequently (20% returned within 24 hours of the index presentation), with very high rates of not waiting for medical assessment (44% as compared with a baseline departmental rate of 7%) and frequent ED attendance (51% attended the ED on four or more occasions in three months). This is a vulnerable patient cohort with high rates of homelessness (66%), co-morbidities (46% had three or more chronic diseases) and alcohol dependence (85%) (Brownlea et al, 2019).

 

Project aim:

Develop co-designed models of care and referral pathways across the health (primary and tertiary), non-government organisations, and Aboriginal health and community organisations.
Strengthen the ED-patient therapeutic relationship.

Establish case management models across the ED-AOD interface to facilitate co-ordinated care to a highly disadvantaged patient group with complex care needs who attend the Emergency Department frequently.  The aim is to minimise ED utilisation by linking people with patient centred community-based care.   

 

Key staff: