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

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

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

% 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 Total557,57120, YearTotal no of patients No of patients who are FA % who are FA , , , , , , , , Total481,3722,

MFA vs EFA Year6 to 10 times/yr11 to 20 times/yr 21 to 30 times/yr >30 times/yr Total Total Year6 to 10 times/yr11 to 20 times/yr21 to 30 times/yr>30 times/yrTotal Total

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