Case Management for Frequent Users of the Emergency Department

Case Management for Frequent Users of the Emergency Department: A Randomized Controlled Trial

The purpose of this study is to evaluate a specific case management intervention for frequent users (FU) of Emergency Department (ED).

Compared to infrequent or non-users, most of the ED-FU visitors are identified as vulnerable patients because they are more likely to be of low social and economical status, be more isolated and live alone. They report more chronic medical conditions, have a higher mortality rate and consume more healthcare resources.

In the literature, interventions aimed at improving the management of ED-FU have demonstrated several positive outcomes, but there are still some knowledge gaps.

The proposed project tests the hypotheses that case management intervention as compared with standard emergency care

• is a more efficient use of healthcare resources and reduces ED attendance,
• is cost-saving and
• improves quality of life,
• altogether leading to favorable cost-utility ratio.

Inclusion Criteria:

• 5 or more attendances during the previous 12 months at the Emergency Department of the University Hospital of Lausanne
• Be capable of communicating in any of the languages spoken by the team (i.e. French, English, German, Italian and Spanish) or through a community interpreter

Exclusion Criteria:

• Patients who cannot give informed consent or are ineligible to receive Case Managers services (e.g. acutely confused, acutely psychotic, intoxicated)
• Patients who are in prison
• Patients with a diagnose of cognitive disorders (delirium, dementia, and other cognitive disorders)
• Patients who are not expected to survive at least 18 months after enrollment
• Patients who will not remain in Switzerland for 12 to 18 months after enrollment
• Family members of a participant already included