Developing a triage tool to predict mortality among High Impact Users in an inner-city Emergency Department

WHY?

• A frequent attender (FA) is anyone who attends ED ≥5 times per year (RCEM).

• At Bristol Royal infirmary (BRI) ED ~1% of attendees account for ~10% of ED attendances per year.

• FAs at BRI ED have a 5-year mortality rate of 20.6%.

• The BRI High Impact User (HIU) team was established to support the FA

Develop a triage tool for High Impact Users (HIUs) at Bristol R The first step, outlined here, was to determine which factors increase mortality in this specific local

HOW?

Ø We collected data on 250 patients FAs attending BRI ED between

Ø Six variables were chosen

Ø Data was collected from electronic patient gender and 5-year mortality was also recorded.

Ø Logistic regression modelling factors best predicted 5-year mortality

Scoring system to identify high risk frequent attenders

Attendances, mental health problems and mortality:

FAs with MH problems who attended 10-20 times per year (n=22) had a much higher mortality rate than those in the >20 attendances group (n=6) where 5-year mortality was 0%.

Data suggests patients with mental health problems have different risks from those without Therefore two different scoring systems to predict mortality were developed

• This is a small-scale project using a specific cohort of HIUs and so our findings are not generalisable.

• This is an under-researched and poorly understood population. We hope ED departments will use these findings to collect data on their own HIU populations.

• Our next step is to pilot the scoring systems and prospectively collect data.