Frequent users of the emergency department: a program to improve care and reduce visits

THE AUTHORS DESCRIBE A CASE-MANAGEMENT PROGRAM for frequent users of the em ergency department. The study had a single-subject design, with evaluation for each patient of the number of visits to the emergency department for a 12-month period before referral to the program and a similar period after i mplementation of an individualized care plan. Referrals were made on the ba sis of 2 or more of the following criteria: chronic medical condition, comp lex medical condition, drug-seeking behaviour, violent behaviour and abusiv e behaviour. A multidisciplinary team developed the individualized care pla ns. Twenty-four patients agreed to participate. For the 12-month period bef ore their referral, these patients accounted for a total of 616 (median 26. 5) visits to the emergency department; for a similar period after implement ation of the care plans, they accounted for 175 (median 6.5) visits. The di fficult-case management program appeared to be effective in reducing the to tal number of visits to the emergency department during the study period an d in improving the care for these patients.