Evaluation of SHarED publishes in BMJ Open Quality

An ARC West evaluation of SHaRED has shown the programme to be successful in reducing emergency department (ED) attendance and hospital admissions among ‘high impact users’ of EDs. Results of the Health Innovation West of England programme, which aims to improve how these patients are managed, have been published in BMJ Open Quality.

In England, patients who attend EDs five or more times a year represent 2% of attendees but account for 11% of attendances. These patients are known as high impact users who often experience extremely challenging situations.

The SHarED (Supporting High impact users in Emergency Departments) programme, which was named ‘Urgent and Emergency Care Safety Initiative of the Year’ at the 2023 HSJ Patient Safety Awards, supported ED teams to introduce personalised care plans for high impact users. These plans helped staff to engage with patients about their behaviour and needs, giving recommendations on how to interact with and care for patients. The programme also promoted collaboration between different specialist teams across the health and care system for more integrated care.

The evaluation showed SHarED was successful in reducing ED attendance and hospital admissions among high impact users.

Emergency department attendance went down by 33% and hospital admissions reduced by 67% for those high impact users enrolled in SHarED where data was available. 

A total of 148 high impact users enrolled in the programme, but the amount of data available for emergency department attendance and hospital admission follow-up varied. Data was available for 86% of SHarED patients for six months before and after being enrolled. 

SHarED enabled training on the management of high impact users to be given to 55% of staff across the emergency departments. 

Interviews showed the staff involved in the programme felt SHarED was very positive for both emergency department staff and high impact users. They believed care was more appropriate, consistent and person-centred. They also felt patients would experience less stigma if staff were more empowered to help them.

The evaluation, ‘Supporting High-impAct useRs in Emergency Departments (SHarED) quality improvement: a mixed-method evaluation’, published in the BMJ Open Quality, also highlighted how SHarED empowered ED  staff and showed that the project improved both care for high impact users and the working conditions of staff.

Overall, it recommended that Integrated Care Boards should consider funding teams focused on these patients and that rollout of the SHarED model could help establish better services and reduce ED attendance and admissions.

Read more about the SHarED project on Health Innovation West of England’s website.