Some evidence that programs aiming to decrease emergency department visits by frequent users are effective

Moe J, Kirkland SW, Rawe E, et al. L'efficacité des interventions visant à réduire les visites aux services d'urgence par les grands utilisateurs d'âge adulte: une revue systématique. Acad Emerg Med. 2017;24:40-52.

Review question

Are programs aimed at decreasing emergency department (ED) visits by frequent users effective? What is the effect of such programs on healthcare costs and the health and well-being of frequent users?  

Background

People who frequently visit EDs contribute to overcrowding and wait-times and cause significant costs to the healthcare system. Frequent users tend to be people with chronic health conditions, mental health disorders and/or social and financial problems and may be better served by other types of care. In many countries, hospitals have started programs aiming to support frequent users and decrease unnecessary visits to the ED.

How the review was done

This is a review of 31 studies conducted from 1985 - 2014. Six studies were randomized-control trials (RCTs) and these were all poor in quality.

• All participants were adults who visited the ED frequently. Some studies focused on specific populations, such as individuals with homelessness, chronic health conditions or substance use problems.
• Study participants took part in different types of programs aiming to decrease ED visits. For example, some participants were directed to appropriate health and social services outside of the hospital, others received individualized assessments and discharge care plans designed to help providers better manage participants’ care.
• Researchers measured how many times participants visited the ED. Some studies also assessed participants’ housing stability (homeless vs. housed), use of healthcare services outside of hospitals, hospitalization and rates of death. In some studies, researchers also measured costs of the programs and healthcare cost savings.
• In the studies that included a control group, results were compared to frequent users who did not participate in programs aiming to decrease ED visits.

What the researchers found

There is some evidence that the programs reduced ED visits by frequent users. However, this finding was not consistently seen in all the studies. In addition, the program approaches, study quality and methods varied among the various studies and were difficult to compare, and the studies that found the programs to be effective were of poor quality. Therefore, we cannot be confident about how well the programs reduce ED visits. The researchers did not find that any program type worked better than others.

Conclusion

Programs aimed at decreasing ED visits by frequent users may be an effective way of reducing visits, saving costs and improving certain health and social outcomes. More high-quality research is needed to confirm these findings and measure the cost-effectiveness of the programs.