Summary
The Supporting High impact users in Emergency Departments (SHarED) project achieved reductions in Emergency Departments from High Impact Users, whilst supporting them to seek healthcare and support in a more appropriate way. A clinician-led innovation, SHarED has now been spread to all Emergency Departments in the West of England region.
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“Taking part in SHarED allowed our HIU Team the time, support and resource to really address the underlying issues which can drive patient requirement for large amounts of unscheduled care. By developing Personal Support Plans, in collaboration with patients and other professionals, we managed to reduce attendance rates, reduce admission rates to hospital and smooth the path of patients when they did attend the Department, thereby supporting our staff in dealing with these patients who often have complex health needs. Feedback from our ED staff was extremely positive. Looking to the future, with thanks to SHarED, we’re continuing to develop our HIU service.”
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Dr Sarah Harper, Pain Consultant and HIU Team Lead, Gloucestershire Hospitals NHS Foundation Trust
What the project involved
High impact users (HIU) of Emergency Departments (EDs) suffer some of the most severe health inequalities in the UK. Patients known as HIUs attended Emergency Departments in the West of England up to 80 times per year. Mental health problems, drug/alcohol use and homelessness account for almost all of the presentations. The SHarED (Supporting High impact users to Emergency Departments) project aimed to change this.
The project had been running at University Hospitals Bristol and Weston hospital (UHBW) for five years and had achieved success in reducing attendances to A&E, while supporting high intensity users (HIUs) to seek support in a more appropriate way.
In 2019, a clinician from the hospital, Dr Rebecca Thorpe, submitted SHarED for Health Innovation West of England’s Evidence into Practice Challenge. This was an open call to healthcare professionals in the region with an evidence-based idea for an innovative project to improve healthcare.
Health Innovation West of England worked collaboratively with Dr Thorpe and the team at UHBW to spread SHarED to all six EDs in the region.
All ED teams from across the region attended monthly meetings to share progress, best practice, challenges and to discuss clinical case studies.
The High Intensity Users (HIUs) teams triage and prioritise patients based on multiple factors. Once prioritised, patients are contacted and asked to contribute to a Personal Support Plan. The Plan is then used by members of staff in the ED to provide a consistent approach to assessment and management, and a multidisciplinary team supports to address any underlying issues through a holistic approach.
Outcomes
The evaluation of the SHarED project, undertaken by NIHR ARC West, published in April 2023, demonstrated:
- 33% reduction in HIU ED attendance in six months before and after taking part in SHarED.
- 67% reduction in HIU hospital admissions in six months before and after taking part in SHarED.
- over 360 staff trained to support HIUs.
- improvements in ED staff feelings of confidence, support and training, and a perception that HIUs were receiving more appropriate care.
In September 2023, SHarED won the title ‘Urgent and Emergency Care Safety Initiative of the Year’ at the HSJ Patient Safety Awards.
Next steps
Whilst funding and support from Health Innovation West of England has now ended, the individual ED teams are working with their trusts to secure ongoing support in order to sustain this enhanced operating model. Some support is also now being provided by NHS England High Intensity User Programme.
You can find out more about the project on the Health Innovation West of England website.
