An analysis of frequent attenders at the accident and emergency department of a local general hospital.

Abstract

The presence of 'frequent attenders' in the local Accident and Emergency (A&E) Department has been an issue amongst A&E personnel. Numerous patients could make use of alternative services which are provided either by the family General Practitioner (GP) or by the Primary Care Medical Officer. This study aims to investigate the characteristics of these attenders, consequently four objectives were presented which included, establishing the criterion of 'frequent attenders', their appropriate and/or inappropriate attendance to the department, those factors that influenced these patients to visit the A&E, and finally, what measures could be adopted to educate these patients and the general public on proper A&E use. A Focus Group meeting was undertaken with the help of experts in the field in order to identify a criterion of a 'frequent attender' and also to achieve definitions of an appropriate and/or inappropriate attender to the department. A self-reported telephone survey was performed on seventy-five (81.5%) participants who fulfilled the criteria of a I frequent attender', that is, a patient visiting the department six (6) or more times in the year 2005. Factors that influenced these attenders to visit the A&E Department and not other alternative available services included; the A&E Department offer better care and service delivery, and that A&E staff are more specialized than Health Centre (HC) staff. The importance of having service facilities 24/7 at Primary Care level with the availability of all necessary resources (ECG taking and radiology services) was another reason for A&E attendance. If these services are in full function at a Primary Care level, then A&E staff would be able to redirect non-urgent cases to this department. In order to establish educational strategies for adequate A&E use the telephone survey results were Critically analysed and presented during a second Focus Group meeting. This meeting revealed that continuous education and training programmes to Primary Care and A&E personnel together with a health promotion and educational campaign are needed in order that optimum health care services and community support are delivered efficiently and effectively to the general public. This study proves to be beneficial to understand the dynamics associated with inappropriate attenders that visit the A&E Department. Thus, investing resources accordingly to limit abuse of emergency services might help in achieving high standards of care for those inappropriate patients examined at the A&E Department. Patients are willing to use alternative services rather than visiting the A&E Department. Hence, management need to invest and allocate all the necessary recourses (human, physical, information and financial) in order that the best quality of care is delivered to our patients.