Description des profils des hauts consommateurs d’un département d’urgence et mise en à l’essai d’une intervention infirmière pour optimiser la trajectoire de soins
Introduction. Patients who frequently use the emergency department (ED) negatively impact ED efficiency. In order to optimize the care trajectory of these frequent users (FU), we have looked for patterns in their use of health care and implemented an intervention adapted to the patterns found. Methodology. The characteristics that describe the patterns of FU health care use, where FU are patients that have visited the ED of the ultra-specialized cardiology hospital seven times or more during a one year period from 2012 to 2013, were chosen based on the theoretical framework of Andersen (2008). The data available in the medical records was collected from the hospital’s electronic databases and analyzed. The intervention, which aims at better understanding the pattern of health care use and patient needs, was developed based on the theoretical framework of Wagner (1998). Suitable patients, who visited the ED at least five times in 2013-2014, were identified for the intervention during one of their visits to the ED. Conclusion. To determine patterns of health care use, we found 31 FU, amassing a total of 272 ED visits. We have observed that the FU of the one year period studied were no longer FU the following year, as only two of them (13%) visited the ED seven times or more during the year after. Those FU who visited outpatient clinics, visited the ED less often than those who did not. Furthermore, the frequency of use and the accessibility of ambulatory care show that multiple FU suffered from chronic illness or severe comorbidity. For the intervention, we have selected and met with five patients. Most of them said they were worried about the consequences that their medical problems could have. However, very few of these patients declared themselves to be ready to change their daily habits in favor of better health. In order to improve care for these patients, individual and organizational interventions were recommended.
Frequent users Emergency department Cardiology