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Doctor Examining Patient


High Intensity User

The service provides a robust way of reducing frequent user activity to 999, A&E, and hospital admissions, freeing up front line resources to focus on more clients and reduce costs. The service uses both a social prescriber and medical approach, targeting high users of services and supporting the most vulnerable patients in community to flourish, whilst making the best use of available resources.​

The principles of the service are:

Identify – The service will identify the top high intensity users of Lewisham Hospital A&E/999 ambulance callers and determines the reason for attending.

Personalise – We contact patients chosen to focus on the clients’ issues, identifying and de-medicalising their needs to uncover the ‘real’ reason for calling 999 or attending A&E. ​

De-escalate – The social prescribers work with the patients and signpost them to other services where appropriate. They are discussed in our MDT where we have a wide range of resources, with mental health, police, GP, homeless team, drug and alcohol teams to name a few.  

Discharge – Many clients, following initial support from the HIU service, are discharged without the need for follow up.​

Manage relapse – Once managed by the service, clients often begin to feel more positive, decrease their dependency and improve their personal outcomes. Relapse can occur but these clients can re-enter service if we notice their attendance increasing, which will immediately pick up their crisis and helps them navigate through the difficult time rather than the need to return to their old behaviour of attending A&E. ​

Quality of intervention – Higher quality more personalised and effective interventions will create robust connections and positive outcomes for clients and deliver financial savings to the system. The impact of these interventions will be assessed by the service in terms of reduced usage of A&E. 

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