The effect of high-intensity use services on frequent emergency department attendance in England: controlled, interrupted, multicentre, time-series analysis of routinely collected electronic health records.

Authors

Akshay Kumar, Catriona Marshall, Sonia Saraiva, William Lee, Suzanne Mason, Chris Burton, Christina M van der Feltz-Cornelis, Stephanie de-la Haye, Robert West, Chris Bojke, Richard Mattock, Samuel Relton, Else Guthrie

Published in

BJPsych open. Volume 12. Issue 6. Pages e280. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

The National Health Service in England has encouraged the development of specialised services for patients with high-intensity use of emergency departments: liaison psychiatry services in emergency departments and community services.
To evaluate the effect of different types of high-intensity use services on attendances at emergency departments, for those with 5 (HU5) or 10 (HU10) or more attendances in the previous 12 months, and the subset of this group with probable mental health problems, versus emergency departments without locality high-intensity use services.
A retrospective longitudinal study was conducted using nationally sourced data from 13 hospitals in England, spanning 1 April 2016 to 1 January 2020. An interrupted time-series analysis assessed the impact of three high-intensity use service models on weekly emergency department attendances: emergency department-based services with and without designated staffing, and community based services. Patients and clinicians contributed throughout the project.
A total of 2 938 510 emergency department attendances were analysed. Statistically significant associations were identified between the implementation of community-based services and reductions in weekly attendances by HU10 patients (rate ratio 0.83, 95% CI 0.71-0.97), and HU5 and HU10 patients with mental health-related attendances (HU5 rate ratio 0.82, 95% CI 0.75-0.91; HU10 rate ratio 0.70, 95% CI 0.59-0.84). Emergency department-based services with designated staff were associated with a reduction in mental health-related attendances among HU10 patients (rate ratio 0.88, 95% CI 0.80-0.98).
Services targeting patients with high-intensity use of emergency departments in England demonstrate promising potential in reducing emergency department attendances among this patient group. Community-based interventions show the most substantial impact, whereas hospital-based services often run by liaison psychiatry teams also contribute to reductions in those with high-intensity use with mental health issues. These findings support further development and expansion of tailored high-intensity use services across the country.

PMID:
42952231
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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