There have been a number of studies, most notably one in Blackpool, that have used a social prescribing intervention to work with individuals who are very frequent visitors to A&E departments to successfully modify their behaviour and reduce their attendance levels.
North Middlesex University Hospital (NMUH) was keen to explore a similar approach, working with us to understand the reasons why a significant number of residents frequently attended the NMUH A&E department and, taking a holistic approach, work with them to address the issues that underpinned this habitual behaviour.
The rationale for this 'pilot study' was that it could provide information that would potentially reduce the numbers attending A&E and phoning the ambulance service; frequent attenders make up a significant number of visits in any one month. This would free up the time of A&E medical staff and ambulance services and help the residents to address their underlying issues in a more constructive and effective way.
- It is clear from the case studies that the clients had a wide range of underlying problems that needed to be addressed which, if resolved, would almost certainly remove their desire to attend A&E.
- There were some surprising explanations, e.g. some clients used A&E attendance as an excuse not to be sanctioned by DWP for failing to meet their job search related obligations.
- Ironically, some of their problems, e.g. fear of debt collectors and being sanctioned by DWP were less of a concern during the lockdown which reduced their anxiety relating to these pressures.
- Some of the frequent attenders were living in care homes and other supported living accommodation.
- Most of the clients did not have a positive experience when they attended A&E which makes their frequent visits even more difficult to understand but highlights the complexity of the reasons for them doing so.