Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation

Area of Science:

• Healthcare Management
• Quality Improvement
• Patient Care

Background:

• Frequent attenders, or high-impact users (HIUs), in emergency departments (EDs) require better management due to complex health needs.
• The Supporting High impAct useRs in Emergency Departments (SHarED) program was initiated to address this by implementing a local intervention across multiple EDs.

Purpose of the Study:

• To evaluate the implementation of the SHarED quality improvement program.
• To assess the impact of SHarED on emergency department attendance and hospital admissions for high-impact users.
• To understand the experiences of ED staff involved in the HIU roles.

Main Methods:

• Analysis of semistructured interviews with 10 HIU staff.
• Tracking the number of ED staff trained in HIU management.
• Administration of an ED staff experience survey.
• Review of ED attendance and hospital admission data for 148 enrolled HIUs.

Main Results:

• Staff with HIU roles reported unanimous positive benefits for both staff and patients.
• 55% of ED staff received training, with reported improvements in confidence, support, and training.
• Mean monthly ED attendances per HIU decreased by 33% (from 2.1 to 1.4) post-enrolment (p<0.001).

Conclusions:

• The SHarED program demonstrates significant potential for quality improvement initiatives.
• It promotes integrated case management across health and care systems for vulnerable individuals.
• The program improves working arrangements for healthcare staff managing high-impact users.