Healthcare providers’ perceptions of difficulties related to frequent users of emergency departments

Abstract

Background Frequent users of emergency department (FUEDs; ≥ 5 ED visits/ year) are often vulnerable individuals cumulating medical, social and substance use problems. FUEDs often require complex and sustained care coordination generally unavailable in ED and are commonly considered contributing to ED crowding. In view of supporting ED health-care providers through specific training and interventions tailored to FUEDs, this study aimed to explore ED healthcare providers’ perceptions of difficulties related to FUEDs. Methods Participants (N = 208) were ED healthcare providers (i.e., nurses, physicians) from 75 university and community hospitals in Switzerland (71% of all EDs) who answered a questionnaire on FUEDs. They were asked to indicate the extent to which FUEDs represent a problem in their ED. Perceived difficulties related to FUEDs were elicited by an open-ended question. Conventional content analysis was used to extract common categories and themes. Results Among the 208 participants, 134 (64%) reported that FUEDs represent a problem. Of those, 132 provided 1 to 5 answers to the open-ended question. Twenty-eight categories were identified and organized in 4 themes. First, participants reported difficulties related to FUEDs’ characteristics themselves (e.g., problem’s chronicity; behavioural difficulties) leading to healthcare complexity. Second, participants perceived negative consequences related to the presence of FUEDs in the ED (e.g., work overload, staff helplessness and fatigue). Third, ED healthcare offer was considered inappropriate and inefficient to respond to FUEDs needs and fourth collaborating with FUEDs’ existing healthcare network was perceived as difficult. Conclusions ED healthcare providers experience a wide range of difficulties related to the management of FUEDs. Providing training and implementing a case management intervention tailored to FUEDs might support ED health-care providers and contribute to address FUEDs’ complex needs. Key messages ED healthcare providers perceive FUEDs to represent a problem. Perceived difficulties might decrease through training and case management support might contribute to better address FUEDs complex needs.

Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

“…This study has several limitations. First, the quantitative survey was not previously validated beyond face validity, although it was used in a previous studies [18,19]. That being said, the survey development went through an expert committee and iterative testing.…”

“…A 12-item online survey was developed to measure variables related to the FUED issue, summarized below and presented in Appendix 1. The survey was based on a version developed by a panel of experts involved with FUED and used in ongoing research [18,19]. As described in Chastonay et al [19], the panel conducted a series of sessions to develop a set of items exploring ED staff's perceptions regarding FUED and associated issues.…”

“…The survey was tested by ED staff (Lausanne university hospital, CHUV; N = 14). The version used in this study was composed by a selection of original items matching with its variables [18,19].…”

Health care providers’ perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland

“…Malone [ 19 ], in her qualitative study, reported that nurses experienced a wide range of difficulties related to the perception of an existing mismatch between the demands of FUEDs and the EDs medico-clinical orientation, resulting in a feeling of failure and affecting their morale. Similarly, a recent pilot qualitative survey in French-speaking Switzerland reported that EDs staff experienced numerous difficulties related to the management of FUEDs suggesting that they may need tailored training, support and resources to address FUEDs’ specific and complex needs [ 20 ]. This has also been addressed in several case reports [ 21 , 22 ].…”

“…There has been a call from health authorities and hospitals in Switzerland for better care of FUEDs via interventions specifically adapted to them, such as the CM [24]. The importance of the FUEDs issue in Switzerland, as reported in various regional surveys [5,[25][26][27] and the scant information on the perceptions of local ED professionals [20] prompted us to conduct a survey at the national level among ED staff (medical doctors and nurses from different linguistic regions and EDs specialization levels) in order to evaluate: a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of CM and interest in implementing this intervention in their ED service. Our study focused on the above mentioned aspects within a larger ongoing research project.…”