1. What did I do? Complex and heterogenous population; difficult to define and characterise Stereotyped image – high cost & burden; inappropriate use Question: Who (which sub- group/persona) is causing the greatest reversible impact on our ED? A service design approach to ED frequent attendance vs

2. Challenges? Frequent attenders workgroup – stakeholder views Challenges of stereotypes Needs amalgamation → incoherent design; elastic user Data (20,965 attendances) → personas How will project inform new service? Alcohol misuse and ODs James 30 times Bob 14 times chest pain but no significant ischaemic disease found recent diagnosis of COPD Kelly 10 times Persona samples MH-related FA Personas: 1.MFA with MUS/somatoform 2.MFA with LTC 3.EFA with self harm or alcohol

3. Lessons learnt 15% of FAs are repeat FAs but account for 50% of attendances FAs have 1 in 4 chance of re- attending within 7 days Moderate ( 20/yr) FAs – 97% of FAs are MFAs Persona samples Recommendations: MFA – Given 97% of FAs are MFAs, need to develop proactive service to identify, assess and treat those that fall within the MFA personas EFA – Target through case management Acknowledgements: Cecily Morrison (EDC) Cathy Walsh (Liaison Psychiatry) CPFT FA working group Addenbrooke’s ED

4. % of total attendances by FAs % of patients attending 6 times or more/year Year Total no. of attendances/yr FA no. of attendances/yr % of FA attendances/Total 20036207716052.59 20046707415732.35 20056884620663.00 20067259923233.20 20078189328823.52 20088468931533.72 20099001935583.95 20109237438054.12 Total557,57120,9653.76 YearTotal no of patients No of patients who are FA % who are FA 200350,1221860.37 200453,5401990.37 200554,7352440.45 200656,9312600.46 200762,9623230.51 200864,8673670.57 200968,5564320.63 201069,6594520.65 Total481,3722,4630.51

5. MFA vs EFA Year6 to 10 times/yr11 to 20 times/yr 21 to 30 times/yr >30 times/yr Total 20031513122 186 20041801720 199 20052053180 244 20062213072 260 20072654765 323 20083104593 367 200938039103 432 20103786383 452 Total20903035218 2463 Year6 to 10 times/yr11 to 20 times/yr21 to 30 times/yr>30 times/yrTotal 2003108740743681605 200412782464901573 2005143243420002066 200615714441661422323 200718376521462472882 200821816152071503153 200926865262401063558 201026528631851053805 Total147244187123681820965

6. YearMFA (<20/year)EFA (>20/year) -No. of FAsNo. of attendancesNo. of FAsNo. of attendances 2003182/186 = 98%1494/1605=93%4/186 = 2%111/1605=7% 2004197/199 = 99%1524/1573=97%2/199 = 1%49/1573=3% 2005236/244 = 97%1866/2066=90%8/244 = 3%200/2066=10% 2006251/260 = 97%2015/2323=87%9/260 = 3%308/2323=13% 2007312/323 = 97%2489/2882=86%11/323 = 3%393/2882=14% 2008355/367 = 97%2796/3153=89%12/367 = 3%357/3153=11% 2009419/432 = 97%3212/3558=90%13/432 = 3%346/3558=10% 2010441/452 = 98%3515/3805=92%11/452 = 2%290/3805=8%