Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

Abstract

BackgroundA minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients.ObjectivesThe present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour.MethodsA retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria.ResultsThe review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month).ConclusionsEffective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour.

A survey of telephone nurses’ experiences in their encounters with frequent callers

“…The challenge the TNs experienced with FCs in the present study is congruent with the study by Holmström et al (), where FCs constituted a challenge for TNs and often comprised the caller's worries and anxieties. Furthermore, in the background it is described that in several studies the FCs were more likely to have psychiatric comorbidity (Corral et al, ; Edwards et al, ; Fisher et al, ; Liu et al, ; Middleton et al, ; Pirkis et al, ; Ramors‐Rivers et al, ; Spittal et al, ), which also seems to be the case in the present study according to these TNs. It has previously been shown that there is a positive relationship between expressions of concern by the caller and disapproval by the nurse (Ernesäter, Engström, Winblad, Rahmqvist, & Holmström, ).…”

“…Although there is no consensus on a definition of the term, the phenomenon of FCs is described in the studies that use the term. In several studies, the FCs were more likely to have psychiatric comorbidity (Corral, Yaur, Diaz, Simmons, & Sussman, ; Edwards, Bassett, Sinden, & Fothergrill, ; Fisher et al, ; Liu et al, ; Middleton et al, ; Pirkis et al, ; Ramors‐Rivers et al, ; Spittal et al, ). Furthermore, a connection has been found between medical‐psychiatric comorbidity and frequent use of primary care resources (Ferrari, Galeazzi, Mackinnon, & Rigatelli, ).…”

Calls for police service

“…For instance, a minority of patients have been found to account for the majority of calls for the ambulance service (Edwards et al, 2014). Similarly, some 'troubled families' who often have many generations displaying the same problems, may require more resources than others (Home Office, n.d).…”

Paramedics’ perceptions of caring for those who self-harm: A Qualitative Study

“…Frequent callers are a high-risk group and more likely to die after their last visit to ED (2.6% of frequent users vs. 1.1% of infrequent users), become hospitalized at higher rates (18.8% vs. 14.2%), and be transported to the ED more frequently by ambulance (18.6% vs. 12.1%) (Fuda & Immekus 2006). Frequent callers to ambulance services are more likely to be assigned call codes of substance misuse than any other condition, followed by psychiatric abnormal behaviour, and between 16-33% of frequent callers present as SH or suicide attempts (Pajonk et al 2001, Edwards et al 2015, Knowlton et al 2013. Busyness and frequent callers are therefore common occurrences in paramedic care.…”

“…People who SH and present to emergency carers also tend also to experience multiple tensions, both psychological and social in nature (Haw & Hawton 2008, Hume & Platt 2007. Such complexity has been found in ambulance service presentations of SH (Edwards et al 2015) and makes it challenging for services to respond to people who SH (Hunter 2003). Psychosocial assessment considers the inter-relationships between psychological and social domains of patients' lives (Hunter 2003), and it is therefore recommended that people who SH receive a psychosocial assessment before discharge (NICE 2004); despite this, only between 42% and 71% of SH presentations receive this assessment (Barr et al 2005;Kapur et al 2008).…”