A&E programme reduces unnecessary attendances and improves standard of care for patients

A team of staff from West Middlesex University Hospital, supported by West London Mental Health Trust (WLMHT), have been working together to make enormous progress in reducing frequent attenders to A&E, and as a result have helped improve the standard of care for their patients.

The programme, led by West Middlesex Hospital, has gone from strength to strength and is now funded by Health Education North West London. The collaborative work of the hospital’s A&E department and WLMHT Liaison Psychiatry, who have provided invaluable consultant psychiatry input, helped recruit more than 65 patients to the programme in 2014 with a 50% success rate of significantly reducing their attendances to A&E.

Every patient who is recognised as a frequent attender is seen by the team and given an individual care plan which is developed in collaboration with the patient, tailored to their individual needs and engages relevant agencies. The care plans provide staff with a clear idea of what investigations are appropriate for the patient and what action has already been taken. This has resulted in reduced pressure on emergency staff and a reduction in unnecessary investigations.

Claire Whittle is a patient at West Middlesex and states that her life has been turned around by the frequent attenders team. Claire used to go to hospital nearly every day with chest pains, for which the A&E staff could find no medical cause. After speaking with the frequent attenders team, it was discovered that Claire’s pains were actually caused by underlying stress and anxiety issues.

Claire explains: “The frequent attenders team have really changed my life for the better. I’ve suffered some personal tragedies in my life, struggled with mental health issues and physical difficulties but they’ve helped me get my confidence back. I now work in Oxfam one day a week, I’m an active campaigner for mental health, I sing at my local Pentecostal church and I’ve also helped with the programme itself; collecting information and leaflets and creating a patient feedback form. None of these things would have happened without the programme.”

Claire’s attendances in A&E have since vastly reduced, her attendances are now appropriate for her health needs and her consultations are much calmer. On top of this, Claire has also lost 3 ½ stone in weight, gone from smoking 60 cigarettes a day to stopping altogether and has become better at controlling her diabetes.

Dr Emma Schofield has been involved since the inception of the programme but states that it was only when the team were joined by Senior Nurse Lisa Newbury and Ms Anne Tanner that they have been able to recruit a larger number of patients and work more intensively with them: “We are delighted with the results we’ve seen so far and Claire’s is a real success story. It really has been a team effort and working in conjunction with Liaison Psychiatry has really helped us address the underlying problems of our frequent attenders and get to the bottom of why they attend A&E so often. It has also improved our relationship with this type of patient; we are better equipped to understand why they come in, realising that there is often a serious underlying reason which is not always their presenting complaint.”

Senior Nurse Lisa Newbury who shares the emergency clinical lead role with Emma Schofield stated: “It is a great project to be a part of and hugely rewarding. I’m particularly proud of the fact that through our work, as well as improving standards of care and saving money, we have also been able to identify and action issues regarding child protection and vulnerable adults, which might otherwise have gone unnoticed.”

Bruce Mamvura, Senior Liaison Psychiatry Nurse, West London Mental Health Trust, also added that this project has dramatically improved the close working relationships between the Liaison Psychiatry team and A&E and has also improved the way mental health patients are treated and supported, not only in A&E but across the whole hospital.