Effects of Case Management on Frequent Users in the Emergency Department: An Integrative Literature Review

Background: Frequent users of the emergency department (ED) can result in overcrowding, compromised quality of care, increased cost, and reduced efficiency. It is hypothesized that case management interventions can decrease the amount of ED visits, therefore improving quality of care, improving patient outcome, and lowering costs.

Objectives: The purpose of this integrative literature review was to identify if case management interventions are an effective way to decrease the number of visits in frequent users of the ED.

Method: An integrative literature review was conducted by searching ProQuest, CINAHL, and PubMed databases. Search terms included “emergency department,” “frequent,” “case manage,*” “overcrowd,*” “quality,” “effective,” and “cost.”

Results: Case management interventions were effective in reducing frequent users of the ED in all eight studies reviewed. Four of the eight studies additionally indicated a decrease in ED costs. Effective interventions included telephone, group, and individual based interventions.

Conclusion: It was found that case management can be applied effectively to decrease visits in frequent users of the ED. Some studies noted interventions were not effective with chronic pain patients or prescription drug misusers. Further research is needed in that area, and additionally in long term sustainability of the reduction of visits.