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National Programme for Wales

Wales leads the way with standardised care for patients who frequently use emergency or unscheduled services

WEDFAN - the "Welsh Emergency Department Frequent Attenders Network" - is a network of teams that links every Emergency Department in Wales. It sits within the governance of the National Programme for Unscheduled Care, Wales, and aligns to the Royal College of Emergency Medicine Guidelines for frequent attender services

Frequently attending patients are those who attend EDs or other health care facilities/services more regularly than other members of the population, defined by the Royal College of Emergency Medicine as 5 times a year or more. This can be for a variety of reasons - including an acute episode of a chronic condition, a rapid escalation in care needs, approaching end of life, and social crisis, amongst others. There is a vast amount of stigma attached to this patient group and there is great need to re-balance this - part of the work of WEDFAN is to provide clarity, evidence and best practice for care provision. Evidence gathered in Wales shows that frequently attending patients come from all specialty areas, including palliative care, respiratory, cardiology and gastroenterology amongst others. Those frequently attending will not be seen as less than others, rather, as an indication that care needs have escalated and need addressing 

Unscheduled care in its many forms is not best placed to meet the needs of this patient cohort - there is a dearth of information needed at point of crisis to make informed decisions about care, a single agency cannot necessarily fulfill all care needs, and often needs are too entrenched to be managed at the point of contact. The solution is to have multi agency services that are set up to provide support and care in a meaningful and joined up manner


Recent legislation in Wales - the Social Services and Well Being (Wales) Act 2016, and the Wellbeing of Future Generations Act create an opportunity for us to redesign services and approaches to frequent attenders, providing a legislative basis to preventative care,  partnership and collaboration - the importance of which has been recognised in the recent Welsh Government paper, A Healthier Wales: our Plan for Health and Social Care

WEDFAN enables us to share resources, research, knowledge and understanding through national events, regular meetings, steering group governance and patient feedback from local teams.  

Principles of the Social Services and Well Being Act


The fundamental principles of the Act are:

 

  • Voice and control – putting the individual and their needs, at the centre of their care, and giving them a voice in, and control over reaching the outcomes that help them achieve well-being

 

  • Prevention and early intervention – increasing preventative services within the community to minimise the escalation of critical need

 

  • Well-being – supporting people to achieve their own well-being and measuring the success of care and support

 

  • Co-production – encouraging individuals to become more involved in the design and delivery of services. 

The most commonly accepted definition for a frequently attending patient is one who comes to a health care facility 5 or more times per year. (RCEM Guidelines 2017)

 

Patients with frequent attendances make up a significant percentage of all attendances - in Wales attendances from this patient cohort make up 8.5% of all ED attendances. Consistent findings from cohort studies show that these patients tend also to be frequent users of other health and social care facilities. Additionally, they tend to have a higher triage category, greater rates of admission, and a greater burden of chronic disease, when compared to matched groups.

The population of patients who are frequent attenders is heterogenous. A UK ED study showed that 45% had Medically Unexplained symptoms, 65% had Mental Health symptoms and 15% had significant alcohol problems

Report Links Adverse Childhood Experiences to Increased A&E Attendances


Our teams consist of Health, Local Authority, Third Sector and Voluntary agencies, and, in collaboration with the patient, undertake an assessment of their:

 

  • medical

  • social

  • physical

  • emotional

  • psychological

  • spiritual

  • financial

  • well-being

  • educational

  • cultural needs


We work with them to understand triggers and crisis points that bring them to the point of needing help regularly, and create bespoke plans that involve all agencies across the board. These help reduce their need for unscheduled services and increase their health and well-being by ensuring they get consistent, appropriate care from the right provider