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May 19, 2020

Covid-19 and alcohol—a dangerous cocktail

Tackling alcohol harms must be an integral part of the nation’s recovery Ilora Finlay chair of Commission on Alcohol Harms , Ian Gilmore chair of Alcohol Health Alliance UK 

April 20, 2020

Suicide risk and prevention during the COVID-19 pandemic

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February 01, 2020

Trauma-informed care for people presenting to the emergency department with mental health issues

Why you should read this article:
● To understand the challenges that people may experience when presenting to the emergency department (ED) with mental
health issues
● To familiarise yourself with the principles of trauma-informed care and the high prevalence of exposure to childhood trauma
among people with mental health issues
● To develop an awareness of the risk of re-traumatising patients during their care in the ED, and how this may be avoided

December 15, 2019

Association of social relationships with incident cardiovascular events and all-cause mortality

Research article to examine how different aspects of social relationships are associated with incident cardiovascular events and all-cause mortality. 

October 23, 2019

Research into the potential for substance switching following the introduction of minimum pricing for alcohol in Wales

This report presents the results of a study investigating the potential consequences of introducing a minimum price for alcohol in Wales with a focus on the possibility of ‘substance switching’. The study was conducted by a consortium of researchers from Figure 8 Consultancy, the University of South Wales and Glyndŵr University.

May 05, 2019

Keir Harding has written a collection of useful links for resources around complex mental health needs

July 18, 2018

Supporting frequent attenders to reduce their visits to an emergency department

Frequent attenders to emergency departments (EDs) are a heterogeneous group who have
traditionally been patched up and discharged with little support. This makes them vulnerable
to over investigation and they often have a poor experience in EDs, which can cause frustration
among the staff who work with them. This article reviews the literature on frequent ED attenders
and explores the related issues. It also describes how a multidisciplinary team (MDT) was formed to
identify people in this group, evaluate their attendances and notes to understand their individual
needs and identify strategies to improve their options and care while in the ED. The rationale for the
formation of the MDT, the process of selecting patients and the

July 31, 2018

Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions (Sarah Deeny, Ruth Thorlby, Adam Steventon)

Patients with long-term conditions spend under 1% of their time in contact with health professionals. The majority of their care, such as monitoring their symptoms and administering medication and treatment, comprises tasks they or their carers manage on a daily basis

We found that patients who were most able to manage their health conditions had 38% fewer emergency admissions than the patients who were least able to. They also had 32% fewer attendances at A&E, were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere and had 18% fewer general practice appointment

February 22, 2018

Frome in Somerset has seen a dramatic fall in emergency hospital admissions since it began a collective project to combat isolation. There are lessons for the rest of the country

December 18, 2017

The ‘Frequent Service User’ Program That Grounded a Hospital’s Soaring Costs In Dallas, Parkland Hospital created an information-sharing network that gets health care to the most vulnerable citizens—before they show up in the emergency room

Parkland Center for Clinical Innovation (or PCCI) was a joint effort with community partners such as homeless shelters and food pantries to build a network of what was hoped would eventually be hundreds of community-based social services around Dallas County, with Parkland Memorial at the center of it.


A sophisticated software platform would enable the hospital to easily refer homeless people discharged from its emergency room to shelters and pantries, and to let social workers at those places see what their clients were doing: whether they were filling their prescriptions, or getting healthy food, or had a place to sleep, or money for the bus. It would be so much cheaper to meet those needs outside the medical system than to pay for the consequences inside it.


Two years into the program, evidence is mounting that PCCI is working.

July 11, 2017

People who suffer childhood trauma are more than twice as likely to use basic health services, a study has found.

Bangor University interviewed 5,400 people in England and about 2,000 people in Wales.

It found people with adverse childhood experiences (ACEs) are more than twice as likely to use A&Es and to be frequent GP surgery users

A collaboration between health, third sector, local authority and other agencies has been set up to a. reduce demand on emergency services and b. support patients who frequently attend by working with them to understand their needs and align care in a meaningful manner. It bases itself completely within the prudent healthcare premise, working with the patient at every step of the way. It reduces unnecessary investigations, streamlines resources, protects the emergency stream and reintegrates patients into local community support. It enables working without walls, bringing unique solutions to entrenched problems, whilst ensuring that an extremely vulnerable cohort of patients is supported through changes to their multi layers of need

June 06, 2017

North East Essex Clinical Commissioning Group (NEE CCG) has been undertaking an exciting piece of work ‘The High Intensity User (HIU)’ project, looking at frequent users of local health services and empowering those individuals to take ownership of their health and well-being whilst decreasing their dependency upon unscheduled care services.

May 03, 2016

  • People who frequently attend Accident and Emergency (A&E) departments for alcohol-related reasons tend to experience alcohol dependence associated with multiple and complex needs, but also report diverse patterns of drinking and other substance use, and varied health and social problems.

  • Although A&E staff are generally sympathetic to the needs of people with complex drinking and related problems, they do not have the resources or training to provide the kind of personalised support that people who frequently attend A&E for alcohol-related reasons often need.

  • Assertive outreach – a treatment model that offers intensive, individualised, caseworker support for patients in the community – seems to offer good potential for helping people who frequently attend A&E for alcohol-related reasons.

January 08, 2014

Find out who the patients are who frequently attend A&E departments, then we can improve care for them and use NHS resources more efficiently, says Ian Blunt

The BBC’s research on frequent users of accident and emergency departments, published yesterday, makes for interesting reading. It found that nearly 12,000 people made more than 10 visits to the same unit in 2012-13, and a small number of those attended more than 50 times. This is an eye catching finding and it is important to consider what those numbers might actually mean

December 01, 2012

Practitioners use various terms to describe those clients who are repeatedly admitted to hospital or attending Accident and Emergency Departments for treatment for alcohol-related conditions e.g. high volume service users, high impact service users, frequent attendees etc. For ease of reference and recall we have adopted ‘Frequent Flyers’ as a working term to identify this client group, although we are aware of pejorative connotations implied by the label. Nationally, 13-20% of all hospital admissions are alcohol-related and this accounts for 35% among A &E attendances (NHS Evidence, 2012). They are known to have some of the highest rates of alcohol-related hospital admissions, thereby placing a considerable burden on NHS resources as well as indicating very poor health outcomes for this client group. Reducing such admissions has become an NHS priority

January 22, 2009

Aims: To assess whether case management of frequent attenders to the emergency department (ED) reduces subsequent attendances made by these patients.

Methods: Patients who attended the ED 10 times or more over a 6-month period were identified. Their cases were assessed and care plans put in place, if appropriate. Patient attendances over the subsequent 6 months were compared.

Results: 57 patients attended the ED 10 times or more over the 6-month period (1.4% of the departmental workload). The median number of ED attendances in this patient group was 12.0 (interquartile range (IQR) 10–14). In the subsequent 6 months following case management of these patients, median attendances in the same 57 patients dropped to 6.0 (IQR 2–13, p<0.001). The total number of attendances in this patient group dropped from 720 to 499, a reduction of 31%.

Conclusions: The findings of this study suggest that individual case management and implementation of care plans may help to reduce subsequent attendances in patients who frequently attend ED.

February 01, 2005

Emergency staff reactions to suicidal and self-harming patients

Staff in the emergency departments of hospitals are
reported as being negative or ambivalent toward suicidal
or self-harming individuals. According to the literature,
these patients are subjected to stigmatization and lack
of empathy. This phenomenon has been linked to a
decreased quality of care offered to these individuals
and to missing an important opportunity to prevent
further suicidal behavior or repetition of deliberate selfharm.
Also, protocols, proper guidelines and education
for the emergency staff call for a revision and an

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