High utilisers of emergency departments: the profile and journey of patients with mental health issues

Abstract

Objective

Frequent presenters to the Emergency Department (ED) are known to have complex physical, behavioural and social needs. The study aimed to analyse the system’s behaviour to generate new insights into ED high utilisers with complex mental health issues.

Methods

A retrospective cohort study of the ED presentations of 200 high utilisers during a 12-month period was conducted. Analyses included psychiatric diagnoses, re-presentation rates, cost-benefit analysis of services and patient journey maps to illustrate the patient experience.

Results

The profiled high utilisers represented nearly a quarter of total ED mental health presentations and were more likely to be single and unemployed. Diagnostically, Borderline Personality Disorder and Schizophrenia predominated. The re-presentation rate was high (70% within 28 days) and mental health attributable costs represented nearly three quarters of total health costs.

Conclusion

The study revealed a disintegrated service system for ED high utilisers with mental health issues, resulting in suboptimal clinical outcomes and substantial costs. To deliver value-based mental healthcare our lessons were; (1) stabilise the system’s interaction with the patient by ensuring service responses are consistent with their enhanced management plan (2) all the system’s parts channel the patient into various support services including psychological treatment with one therapist.

KEY POINTS

• The top 200 high utilisers presented to emergency 1928 times within 12 months

• The re-presentation rate amongst the study’s cohort was high (70% within 28 days)

• A high prevalence of BPD and schizophrenia was noted for this cohort

• The study reveals a disintegrated service system for ED high utilisers, resulting in suboptimal clinical outcomes and substantial costs for the service

• A need for early identification, consistency in service responses and various support services to be provided by the hospital including psychological treatment

Keywords:

• Re-presentation rates
• emergency department presentations
• complex patients
• diagnoses
• cost-benefit analysis
• patient journey map

Acknowledgments

The authors wish to acknowledge and thank Ivana Vargovic and Tracey Hewitt for their contribution to this project. We would also like to acknowledge the following staff who assisted in the development of our patient journey map: Amanda Hurley, Ashley Zheng, Darian Winspear, Elissa Ricchetti, Jamie Tratt, Jocelyn Clarke. We would also like to thank Kristen Barry for her assistance with proof reading the article and to Ashley Zheng and Jocelyn Clarke for their assistance in article formatting. This study was supported by the Mental Health Program at Monash Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).