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“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

  • Deborah Wise-Harris
  • Daniel Pauly
  • Deborah Kahan
  • Jason Tan de Bibiana
  • Stephen W. Hwang
  • Vicky StergiopoulosEmail author
Original Article

Abstract

The experiences of individuals with mental illness and addictions who frequently present to hospital emergency departments (EDs) have rarely been explored. This study reports findings from self-reported, quantitative surveys (n = 166) and in-depth, qualitative interviews (n = 20) with frequent ED users with mental health and/or substance use challenges in a large urban centre. Participants presented to hospital for mental health (35 %), alcohol/drug use (21 %), and physical health (39 %) concerns and described their ED visits as unavoidable and appropriate, despite feeling stigmatized by hospital personnel and being discharged without expected treatment. Supporting this population may require alternative service models and attention to staff training in both acute and community settings.

Keywords

Frequent emergency department users Mental health service provision Consumer perspective 

References

  1. Affleck, A., Parks, P., Drummond, A., Rowe, B. H., & Ovens, H. J. (2013). Emergency department overcrowding and access block. CJEM, 15(06), 359–370.CrossRefPubMedGoogle Scholar
  2. Althaus, F., Paroz, S., Hugli, O., Ghali, W. A., Daeppen, J.-B., Peytremann-Bridevaux, I., & Bodenmann, P. (2011). Effectiveness of interventions targeting frequent users of emergency departments: A systematic review. Annals of Emergency Medicine, 58(1), 41–52. doi: 10.1016/j.annemergmed.2011.03.007. e42.CrossRefPubMedGoogle Scholar
  3. Bernstein, S. L. (2006). Frequent emergency department visitors: The end of inappropriateness. Annals of Emergency Medicine, 48(1), 18–20. doi: 10.1016/j.annemergmed.2006.03.033.CrossRefPubMedGoogle Scholar
  4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi: 10.1191/1478088706qp063oa.CrossRefGoogle Scholar
  5. Byrne, M., Murphy, A. W., Plunkett, P. K., McGee, H. M., Murray, A., & Bury, G. (2003). Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics. Annals of Emergency Medicine, 41(3), 309–318. doi: 10.1067/mem.2003.68.CrossRefPubMedGoogle Scholar
  6. Clarke, D. E., Dusome, D., & Hughes, L. (2007). Emergency department from the mental health client’s perspective. International Journal of Mental Health Nursing, 16(2), 126–131. doi: 10.1111/j.1447-0349.2007.00455.x.CrossRefPubMedGoogle Scholar
  7. Crowley, J. J. (2000). A clash of cultures: A&E and mental health. Accident and Emergency Nursing, 8(1), 2–8. doi: 10.1054/aaen.1999.0061.CrossRefPubMedGoogle Scholar
  8. Doupe, M. B., Palatnick, W., Day, S., Chateau, D., Soodeen, R., Burchill, C., et al. (2012). Frequent users of emergency departments: Developing standard definitions and defining prominent risk factors. Annals of Emergency Medicine, 60(1), 24–32.CrossRefPubMedGoogle Scholar
  9. Fossey, E. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36(6), 717–732.CrossRefPubMedGoogle Scholar
  10. Fuda, K. K., & Immekus, R. (2006). Frequent users of Massachusetts emergency departments: A statewide analysis. Annals of Emergency Medicine, 48(1), 9–16. doi: 10.1016/j.annemergmed.2006.03.001.CrossRefPubMedGoogle Scholar
  11. Gill, J. M. (1994). Nonurgent use of the emergency department: Appropriate or not? Annals of Emergency Medicine, 24(5), 953–957. doi: 10.1016/S0196-0644(94)70213-6.CrossRefPubMedGoogle Scholar
  12. Gill, J. M., Reese, C. L, 4th, & Diamond, J. J. (1996). Disagreement among health care professionals about the urgent care needs of emergency department patients. Annals of Emergency Medicine, 28(5), 474–479. doi: 10.1016/S0196-0644(96)70108-7.CrossRefPubMedGoogle Scholar
  13. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: strategies for qualitative research. New York: Aldine.Google Scholar
  14. Gordon, J., Sheppard, L. A., & Anaf, S. (2010). The patient experience in the emergency department: A systematic synthesis of qualitative research. International Emergency Nursing, 18(2), 80–88. doi: 10.1016/j.ienj.2009.05.004.CrossRefPubMedGoogle Scholar
  15. Howard, M. S., Davis, B. A., Anderson, C., Cherry, D., Koller, P., & Shelton, D. (2005). Patients’ perspective on choosing the emergency department for nonurgent medical care: A qualitative study exploring one reason for overcrowding. Journal of Emergency Nursing: JEN, 31(5), 429–435. doi: 10.1016/j.jen.2005.06.023.CrossRefPubMedGoogle Scholar
  16. Hunt, K. A., Weber, E. J., Showstack, J. A., Colby, D. C., & Callaham, M. L. (2006). Characteristics of frequent users of emergency departments. Annals of Emergency Medicine, 48(1), 1–8. doi: 10.1016/j.annemergmed.2005.12.030.CrossRefPubMedGoogle Scholar
  17. Kumar, G. S., & Klein, R. (2013). Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: A systematic review. The Journal of Emergency Medicine, 44(3), 717–729.CrossRefPubMedGoogle Scholar
  18. LaCalle, E., & Rabin, E. (2010). Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of Emergency Medicine, 56(1), 42–48. doi: 10.1016/j.annemergmed.2010.01.032.CrossRefPubMedGoogle Scholar
  19. Lowe, R. A., & Schull, M. (2011). On Easy solutions. Annals of Emergency Medicine, 58(3), 235–238. doi: 10.1016/j.annemergmed.2011.03.054.CrossRefPubMedGoogle Scholar
  20. Lucas, R. H., & Sanford, S. M. (1998). An analysis of frequent users of emergency care at an urban university hospital. Annals of Emergency Medicine, 32(5), 563–568.CrossRefPubMedGoogle Scholar
  21. Malone, R. E. (1996). Almost “like family”: Emergency nurses and “frequent flyers”. Journal of Emergency Nursing, 22(3), 176–183. doi: 10.1016/S0099-1767(96)80102-4.CrossRefPubMedGoogle Scholar
  22. Maslach, C., & Goldberg, J. (1998). Prevention of burnout: New perspectives. Applied and Preventive Psychology, 7(1), 63–74. doi: 10.1016/S0962-1849(98)80022-X.CrossRefGoogle Scholar
  23. Mautner, D. B., Pang, H., Brenner, J. C., Shea, J. A., Gross, K. S., Frasso, R., & Cannuscio, C. C. (2013). Generating hypotheses about care needs of high utilizers: Lessons from patient interviews. Population Health Management, 16(Suppl 1), S26–S33. doi: 10.1089/pop.2013.0033.PubMedGoogle Scholar
  24. Mehl-Madrona, L. E. (2008). Prevalence of psychiatric diagnoses among frequent users of rural emergency medical services. Canadian Journal of Rural Medicine: The Official Journal of the Society of Rural Physicians of Canada = Journal Canadien De La Médecine Rurale: Le Journal Officiel De La Société De Médecine Rurale Du Canada, 13(1), 22–30.Google Scholar
  25. Minassian, A., Vilke, G. M., & Wilson, M. P. (2013). Frequent emergency department visits are more prevalent in psychiatric, alcohol abuse, and dual diagnosis conditions than in chronic viral illnesses such as hepatitis and human immunodeficiency virus. The Journal of Emergency Medicine, 45(4), 520–525. doi: 10.1016/j.jemermed.2013.05.007.CrossRefPubMedGoogle Scholar
  26. Morse, J. M., & Field, P. A. (1995). Qualitative research methods for health professionals. Thousand Oaks: SAGE.Google Scholar
  27. Nairn, S., Whotton, E., Marshal, C., Roberts, M., & Swann, G. (2004). The patient experience in emergency departments: A review of the literature. Accident and Emergency Nursing, 12(3), 159–165. doi: 10.1016/j.aaen.2004.04.001.CrossRefPubMedGoogle Scholar
  28. Nystrom, M., Dahlberg, K., & Carlsson, G. (2003). Non-caring encounters at an emergency care unit—a life-world hermeneutic analysis of an efficiency-driven organization. International Journal of Nursing Studies, 40(7), 761–769. doi: 10.1016/S0020-7489(03)00053-1.CrossRefPubMedGoogle Scholar
  29. Olsson, M., & Hansagi, H. (2001). Repeated use of the emergency department: Qualitative study of the patient’s perspective. Emergency Medicine Journal, 18(6), 430–434. doi: 10.1136/emj.18.6.430.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Olthuis, G., Prins, C., Smits, M.-J., van de Pas, H., Bierens, J., & Baart, A. (2014). Matters of concern: A qualitative study of emergency care from the perspective of patients. Annals of Emergency Medicine, 63(3), 311–319. doi: 10.1016/j.annemergmed.2013.08.018. e2.CrossRefPubMedGoogle Scholar
  31. Pines, J. M., Asplin, B. R., Kaji, A. H., Lowe, R. A., Magid, D. J., Raven, M., et al. (2011). Frequent users of emergency department services: Gaps in knowledge and a proposed research agenda. Academic Emergency Medicine, 18(6), e64–e69. doi: 10.1111/j.1553-2712.2011.01086.x.CrossRefPubMedGoogle Scholar
  32. Pope, W. S. (2011). Another face of health care disparity: Stigma of mental illness. Journal of Psychosocial Nursing and Mental Health Services, 49(9), 27–31. doi: 10.3928/02793695-20110802-01.CrossRefPubMedGoogle Scholar
  33. Potter, C. (2006). To what extent do nurses and physicians working within the emergency department experience burnout: A review of the literature. Australasian Emergency Nursing Journal, 9(2), 57–64. doi: 10.1016/j.aenj.2006.03.006.CrossRefGoogle Scholar
  34. Redelmeier, D., Molin, J. P., & Tibshirani, R. J. (1995). A randomised trial of compassionate care for the homeless in an emergency department. The Lancet, 345, 1131–1134.CrossRefGoogle Scholar
  35. Rising, K. L., Padrez, K. A., O’Brien, M., Hollander, J. E., Carr, B. G., & Shea, J. A. (2015). Return visits to the emergency department: The patient perspective. Annals of Emergency Medicine, 65(4), 377–386. doi: 10.1016/j.annemergmed.2014.07.015. e3.CrossRefPubMedGoogle Scholar
  36. Skosireva, A., O’Campo, P., Zerger, S., Chambers, C., Gapka, S., & Stergiopoulos, V. (2014). Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Services Research, 14(1), 376. doi: 10.1186/1472-6963-14-376.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Soril, L. J. J., Leggett, L. E., Lorenzetti, D. L., Noseworthy, T. W., & Clement, F. M. (2015). Reducing frequent visits to the emergency department: A systematic review of interventions. PLoS ONE, 10(4), e0123660. doi: 10.1371/journal.pone.0123660.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Vandyk, A. D., Harrison, M. B., VanDenKerkhof, E. G., Graham, I. D., & Ross-White, A. (2013). Frequent emergency department use by individuals seeking mental healthcare: A systematic search and review. Archives of Psychiatric Nursing, 27(4), 171–178. doi: 10.1016/j.apnu.2013.03.001.CrossRefPubMedGoogle Scholar
  39. Webster, F., Christian, J., Mansfield, E., Bhattacharyya, O., Hawker, G., Levinson, W., et al. (2015). Capturing the experiences of patients across multiple complex interventions: A meta-qualitative approach. BMJ Open, 5(9), e007664. doi: 10.1136/bmjopen-2015-007664.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Welch, S. J. (2010). Twenty years of patient satisfaction research applied to the emergency department: A qualitative review. American Journal of Medical Quality, 25(1), 64–72. doi: 10.1177/1062860609352536.CrossRefPubMedGoogle Scholar
  41. Wellstood, K., Wilson, K., & Eyles, J. (2005). “Unless you went in with your head under your arm”: Patient perceptions of emergency room visits. Social Science and Medicine, 61(11), 2363–2373. doi: 10.1016/j.socscimed.2005.04.033.CrossRefPubMedGoogle Scholar
  42. Young, G. P., Wagner, M. B., Kellermann, A. L., Ellis, J., & Bouley, D. (1996). Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group. JAMA, 276(6), 460–465.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Deborah Wise-Harris
    • 1
  • Daniel Pauly
    • 1
  • Deborah Kahan
    • 2
  • Jason Tan de Bibiana
    • 1
  • Stephen W. Hwang
    • 1
    • 3
  • Vicky Stergiopoulos
    • 1
    • 2
    Email author
  1. 1.Centre for Research on Inner City Health, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  2. 2.Department of PsychiatryUniversity of TorontoTorontoCanada
  3. 3.Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada

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