Insight report: High intensity users of A&E departments

Dr Foster has carried out a detailed analysis of accident and emergency (A&E) attendances nationally with the aim of uncovering common characteristics of high intensity users (HIUs) - people who attended 10 or more times in a 12-month period - and patterns in HIU attendances to provide valuable insight and a better understanding of the reasons they attend with such high frequency.

The analysis examining data from A&E departments across England in the year to May 2018 revealed that 10 patients attended A&E 2,000 times between them in one year while 31,492 people attended A&E more than 10 times a year.

The findings showed 31,492 people, 0.4 per cent of all patients, made more than half a million visits to A&E, equivalent to 4 per cent of all A&E attendances. Ten patients visited A&E over 235 times each, with some attending, on average, in excess of once a day.

The analysis suggests a relatively small cohort of people are receiving a significant allocation of NHS resources compared to the average population. This is increasing the pressure on the NHS and contributing to the rising cost of healthcare. As well as determining which individuals use A&E services more than others, it is also important to understand why they are visiting A&E so frequently. Such high attendance suggests that their needs are not being addressed elsewhere in the system and they may be better served with specialist care.

With A&E attendances at an all-time high, reducing people’s reliance on urgent and emergency care has been an area of focus for the NHS in recent years. Numerous initiatives have been launched to encourage the public to consider whether they really need to visit A&E. However, successful initiatives specifically targeting HIUs, suggest that this group of patients may require a more personalised approach.

One such initiative saw Dr Foster and the team at Aintree University Hospital analyse data on high intensity users. The most common reasons for re-attendance were persistent pain and, in particular, clinical presentations that frequently involved presentation of medically unexplained symptoms (MUS).

Analyses of this kind will play an important role in reducing HIU attendances. Localised data will help NHS hospitals understand why HIUs are attending regularly, and how they can be aided to better manage their health at home, or use primary healthcare.

“This analysis of HIUs brings us closer to understanding the needs of this group of patients. It is important for the NHS to have access to high quality data that gives them a local picture of access to A&E, to help inform the best way for them to address the healthcare needs of their local community.” Jason Harries, managing director