The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department

Med J Aust. 2006 Jun 19;184(12):602-6. doi: 10.5694/j.1326-5377.2006.tb00412.x.


Objective: To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED.

Design: Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial.

Setting: Inner urban tertiary hospital ED.

Participants: Frequent ED attenders who received CM.

Main outcome measures: ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement.

Results: 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgroup was unaffected by CM (297 v 300, P = 0.8). Admissions for ED overnight observation increased as a result of CM (P = 0.025). CM increased scores for housing stability (P = 0.007), primary care linkage (P = 0.003), and community care engagement (P < 0.001) for the whole group and variously within subgroups. Drug and alcohol use was unaffected by CM.

Conclusion: ED-initiated, multidisciplinary CM appears to increase ED utilisation and have a positive effect on some psychosocial factors for frequent attenders. A trend towards increased ED attendance and utilisation with CM may have implications for policies that seek to divert frequent attenders away from hospitals.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Case Management / statistics & numerical data*
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Care Team / statistics & numerical data*
  • Primary Health Care / statistics & numerical data
  • Retrospective Studies
  • Substance-Related Disorders / therapy
  • Victoria