{
  "abstract": "Why did you do this work? Frequent attenders to Emergency Departments (EDs) contribute to overcrowding, long wait times, increased workload, and financial pressures on an already stretched health care service. 1 In this Paediatric Emergency Department (PED) we see a number of children who are ‘frequent attenders’.Understanding the characteristics of these frequent attenders is crucial for developing targeted interventions. Previous studies have shown themes include children <5 years, chronic health conditions, and psychosocial factors including mental health and parental anxiety.2 What did you do? In December 2023 a multidisciplinary group was set up in the Paediatric Emergency Department (PED) to identify patients frequently attending the PED and to gain insight into factors influencing attendances. Patients included were <16 years old who attended the PED ≥7 times within a 3-month period (pulled from electronic case records) as well as patients identified by PED clinicians. Case notes are reviewed and discussed at a monthly meeting. 70 retrospective patient records were analysed from December 2023- July 2024.Cases are reviewed to see how targeted interventions can ensure that children/families receive the right care, in the right place at the right time.1 What did you find? Factors contributing to increased number of ED attendances are complex. Themes identified were: expectations of the health service; parental worry/overestimation of the severity of their child’s illness; heightened anxiety due to previous hospital admissions/chronic underlying health conditions. Also difficulty in accessing their GP in terms of location or ease of getting appointments.Frequent attenders identified constituted approximately 0.14% of all ED attendances in the time period. 30 (43%) of children were highlighted for health visitor/school nurse support including safeguarding supervision. 21 (30%) were referred to another service/speciality, including the respiratory rapid access clinic. 10 (14%) were known to the hospital with a chronic condition. 5 (7%) of families were educated on other services available. 4 (6%) parents were felt to have significant health anxiety. There were 4 (6%) presentations with childhood mental health concerns and in 4 (6%) there was a safeguarding concern.What does it mean? Reducing frequent attendances requires a multifaceted approach. 3 We have identified common themes and will continue to build patient and public partnerships.4 Multi-agency working should continue, and we aim to submit a business case for a health visitor based in the PED.The frequent attender’s group has raised awareness amongst ED clinicians and enabled staff to discuss openly with families who attend the department frequently. Parental/caregiver education is vital, with signposting to alternative services, empowering self-care for limited ailments/illness, and encouraging the use of primary care. A frequent attender’s leaflet with links to resources has been developed to be used in the ED to aid discussion with families. We hope that this model can be used elsewhere to improve patient care.References Greenfield, et al. BMJ Open 2021.Malcolm, et al. PLoS ONE 2022.Blair, et al. Archives of Disease in Childhood 2017.Jacob, et al. Clinical Medicine 2016.",
  "authors": [
    {
      "affiliations": [
        "Alder Hey Children’s Hospital"
      ],
      "name": "Melissa Leadbetter"
    },
    {
      "affiliations": [
        "Alder Hey Children’s Hospital"
      ],
      "name": "Angela Armitage"
    },
    {
      "affiliations": [
        "Alder Hey Children’s Hospital"
      ],
      "name": "Charlotte Durand"
    }
  ],
  "title": "8454 Management of frequent attenders to a paediatric emergency department",
  "uid": "a0eddbb0-8e7d-514e-8ae4-84fa005d7095"
}