Premium
The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department
Author(s) -
Phillips Georgina Ann,
Brophy David S,
Weiland Tracey J,
Chenhall Antony J,
Dent Andrew W
Publication year - 2006
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2006.tb00412.x
Subject(s) - medicine , psychosocial , emergency department , triage , attendance , population , emergency medicine , cohort , retrospective cohort study , family medicine , psychiatry , environmental health , economics , economic growth
Objective: To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED. Design: Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 – 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial. Setting: Inner urban tertiary hospital ED. Participants: Frequent ED attenders who received CM. Main outcome measures: ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement. Results: 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgroup was unaffected by CM (297 v 300, P = 0.8). Admissions for ED overnight observation increased as a result of CM ( P = 0.025). CM increased scores for housing stability ( P = 0.007), primary care linkage ( P = 0.003), and community care engagement ( P < 0.001) for the whole group and variously within subgroups. Drug and alcohol use was unaffected by CM. Conclusion: ED‐initiated, multidisciplinary CM appears to increase ED utilisation and have a positive effect on some psychosocial factors for frequent attenders. A trend towards increased ED attendance and utilisation with CM may have implications for policies that seek to divert frequent attenders away from hospitals.