Reducing frequent visits to the emergency department: a systematic review of interventions.
<h4>Objective</h4>The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population.<h4>Methods</h4>Systematic review of the literature from 1950-January 2015. Studies...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2015-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0123660 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850113553062690816 |
|---|---|
| author | Lesley J J Soril Laura E Leggett Diane L Lorenzetti Tom W Noseworthy Fiona M Clement |
| author_facet | Lesley J J Soril Laura E Leggett Diane L Lorenzetti Tom W Noseworthy Fiona M Clement |
| author_sort | Lesley J J Soril |
| collection | DOAJ |
| description | <h4>Objective</h4>The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population.<h4>Methods</h4>Systematic review of the literature from 1950-January 2015. Studies were included if they: had a control group (controlled trials or comparative cohort studies), were set in an ED or acute care facility, and examined the impact of an intervention to reduce frequent ED use in a general adult population. Studies reporting non-original data or focused on a specific patient population were excluded. Study design, patient population, intervention, the frequency of ED visits, and costs of frequent ED use and/or interventions were extracted and narratively synthesized.<h4>Results</h4>Among 17 included articles, three intervention categories were identified: case management (n = 12), individualized care plans (n = 3), and information sharing (n = 2). Ten studies examining case management reported reductions in mean (-0.66 to -37) or median (-0.1 to -20) number of ED visits after 12-months; one study reported an increase in mean ED visits (+2.79); and one reported no change. Of these, 6 studies also reported reduced hospital costs. Only 1 study evaluating individualized care plans examined ED utilization and found no change in median ED visits post-intervention. Costs following individualized care plans were also only evaluated in 1 study, which reported savings in hospital costs of $742/patient. Evidence was mixed regarding information sharing: 1 study reported no change in mean ED visits and did not examine costs; whereas the other reported a decrease in mean ED visits (-16.9) and ED cost savings of $15,513/patient.<h4>Conclusions</h4>The impact of all three frequent-user interventions was modest. Case management had the most rigorous evidence base, yielded moderate cost savings, but with variable reductions in ED use. Future studies evaluating non-traditional interventions, tailoring to patient subgroups or socio-cultural contexts, are warranted. |
| format | Article |
| id | doaj-art-70ef2b8d62d24ceca3775a919390f11c |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-70ef2b8d62d24ceca3775a919390f11c2025-08-20T02:37:06ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01104e012366010.1371/journal.pone.0123660Reducing frequent visits to the emergency department: a systematic review of interventions.Lesley J J SorilLaura E LeggettDiane L LorenzettiTom W NoseworthyFiona M Clement<h4>Objective</h4>The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population.<h4>Methods</h4>Systematic review of the literature from 1950-January 2015. Studies were included if they: had a control group (controlled trials or comparative cohort studies), were set in an ED or acute care facility, and examined the impact of an intervention to reduce frequent ED use in a general adult population. Studies reporting non-original data or focused on a specific patient population were excluded. Study design, patient population, intervention, the frequency of ED visits, and costs of frequent ED use and/or interventions were extracted and narratively synthesized.<h4>Results</h4>Among 17 included articles, three intervention categories were identified: case management (n = 12), individualized care plans (n = 3), and information sharing (n = 2). Ten studies examining case management reported reductions in mean (-0.66 to -37) or median (-0.1 to -20) number of ED visits after 12-months; one study reported an increase in mean ED visits (+2.79); and one reported no change. Of these, 6 studies also reported reduced hospital costs. Only 1 study evaluating individualized care plans examined ED utilization and found no change in median ED visits post-intervention. Costs following individualized care plans were also only evaluated in 1 study, which reported savings in hospital costs of $742/patient. Evidence was mixed regarding information sharing: 1 study reported no change in mean ED visits and did not examine costs; whereas the other reported a decrease in mean ED visits (-16.9) and ED cost savings of $15,513/patient.<h4>Conclusions</h4>The impact of all three frequent-user interventions was modest. Case management had the most rigorous evidence base, yielded moderate cost savings, but with variable reductions in ED use. Future studies evaluating non-traditional interventions, tailoring to patient subgroups or socio-cultural contexts, are warranted.https://doi.org/10.1371/journal.pone.0123660 |
| spellingShingle | Lesley J J Soril Laura E Leggett Diane L Lorenzetti Tom W Noseworthy Fiona M Clement Reducing frequent visits to the emergency department: a systematic review of interventions. PLoS ONE |
| title | Reducing frequent visits to the emergency department: a systematic review of interventions. |
| title_full | Reducing frequent visits to the emergency department: a systematic review of interventions. |
| title_fullStr | Reducing frequent visits to the emergency department: a systematic review of interventions. |
| title_full_unstemmed | Reducing frequent visits to the emergency department: a systematic review of interventions. |
| title_short | Reducing frequent visits to the emergency department: a systematic review of interventions. |
| title_sort | reducing frequent visits to the emergency department a systematic review of interventions |
| url | https://doi.org/10.1371/journal.pone.0123660 |
| work_keys_str_mv | AT lesleyjjsoril reducingfrequentvisitstotheemergencydepartmentasystematicreviewofinterventions AT lauraeleggett reducingfrequentvisitstotheemergencydepartmentasystematicreviewofinterventions AT dianellorenzetti reducingfrequentvisitstotheemergencydepartmentasystematicreviewofinterventions AT tomwnoseworthy reducingfrequentvisitstotheemergencydepartmentasystematicreviewofinterventions AT fionamclement reducingfrequentvisitstotheemergencydepartmentasystematicreviewofinterventions |