Does case management provide support for staff facing frequent users of emergency departments?

Background. Frequent users of emergency departments (FUED; > 5 ED visits during the preceding 12 months) account for a disproportionate part of ED visits, causing a wide range of work difficulties to ED staff potentially leading to FUED discrimination. Whereas case management (CM) tailored to FUED generally leads to a modest reduction in ED visits, the effect of CM on ED staff’s perception of FUED issue has not been explored yet. In response, this explorative study aimed to compare ED staff’s perceptions of FUED in two hospitals, one with and one without a dedicated CM service for FUED. Method. Participants (n=253) were ED staff (81 physicians; 172 nurses/assistant nurses), one with CM and one without CM implementation. Perceptions regarding FUED (i.e., FUED-related knowledge, FUED issue extent; related work difficulties; FUEDs’ legitimate use of ED resources) were measured with a 12-item online survey. Independent samples T-Test were conducted to compare ED staff perceptions of FUED. Perceptions of FUED were also explored qualitatively through one-on-one interviews (n=6) and focus groups (n=2). A conventional content analysis was used to explore perceptions regarding FUED issue in each group. Results. Quantitative results indicated that perceived level of FUED-related knowledge was higher in the group with CM. Quantitative and qualitative findings showed yet that actual knowledge were respectively similar and considered modest in the two groups. Whereas there was no quantitative difference between groups regarding perceptions of FUED frequentation, physicians with CM perceived the level of FUED issue extent lower than those without. Further quantitative results revealed that nurses with CM felt more helpless than those without CM. Finally, perception of FUEDs’ legitimacy to use ED was not significantly different between groups, whereas unexpected quantitative and qualitative findings indicated that a subgroup of ED staff without CM was more prone to consider FUED use of ED as legitimate. Conclusion. Although explorative, the results of this study suggest that the support provided to ED staff by a dedicated CM service for FUED is modest. Other means to improve support to ED staff working with FUED could involve providing more teaching and feedbacks on a regular basis to ED staff on CM activity as well as promoting multidisciplinary care in ED to address FUED care complexity