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QUALITY IMPROVEMENT IN ACTION
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The “Frequent Attendee” project: A multidisciplinary approach to identifying important factors, which influence frequent attendances to the emergency department


 King Abdullah Specialist Children’s Hospital, Riyadh, Kingdom of Saudi Arabia; University of South Wales, Pontypridd, Wales; Royal College of Nursing; The Nursing and Midwifery Council, London, UK, Saudi Arabia; UK

Correspondence Address:
Angela T Caswell,
Ministry of National Guard, Ar Rimayah, Riyadh 14611
Saudi Arabia; UK
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JQSH.JQSH_18_18

Background: During routine emergency department (ED) patient attendance validation, a trend began to emerge, related to the reason for frequent attendance among individuals. Dialogue among staff in the department who referred to this client group as “regulars” was concerning, as it was believed that it might lead to a degree of unintentional complacency that might result in a potentially vulnerable group slipping through the net. The aim was to examine the unique profile of frequent attendees, establish preventative factors, and develop action plans to offer more specific support. A multidisciplinary team was formed to examine the profiles of these cases and develop specific action plans to address their unique needs in an attempt to prevent unnecessary admissions to the ED at Cwm Taf University Health Board, South Wales. Materials and Methods: Using a Plan–Do–Study–Act methodology over 18 months, a trend analysis identified specific demographic characteristics of age and sex of the sample group (n = 11). The main reasons for attendance were related to alcohol, substance misuse, and learning disabilities. Results: Results showed that the group included eight males, five of which fell into the 18–25 age group and attended on weekdays, with peak times between 9 am and 5 pm. The other three men fell into the 26–35 age group and attended most frequently after 5 pm, with the peak day being Thursdays. Weekend activity was sustained among the 18–25 age group, and the 26–35 age group had the highest attendances on Sundays. Three females from this group fell into the 26–35 age group and reflected no difference in attendance patterns. Common factors of the sample were unemployment and a socially deprived location. Conclusion: The project resulted in a 75% reduction in visits to the ED from this group of patients. Networking with other hospitals in the area yielded reports that only one of the patients had changed areas and attended another department.


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