FUsED Study: Frequent users of the Emergency Department: Improving and standardizing services- a mixed methods study


A small number of people account for a large number of attendances at urgent and emergency care including emergency departments (EDs), NHS 111 and 999. These people, who are referred to as 'frequent users', usually suffer from both mental health and physical health problems.

Recently, EDs across England have been encouraged to set up services for frequent users. However, we still know little about how well these services work for patients, or how much they prevent people from repeatedly attending EDs.

We aim to improve services for frequent users by understanding which activities are carried out by emergency services for them, how the services bring about change, and what difference they make. This will enable us to develop ideas (programme theories) about change which includes which aspects of services are important, how they work and which patients they help most. We can then develop guidance on activities likely to bring benefit to frequent users in order to help new services get started and current services to focus on this public. 

RESEARCH. There are 4 work streams:

  • Work stream 1 will map what frequent user services are available across England and interview staff to understand what they actually do to help frequent users. 
  • Work stream 2 will use healthcare data to understand how and when people use services frequently. We will assess the impact of frequent users services on ED attendances and estimate costs and savings by comparing EDs with and without those services.
  • Work stream 3 will bring together the findings of Work streams 1 & 2 to develop theories about how different interventions affect different groups of frequent users. We will then test these theories with staff and patients of 4 different services. 
  • Work stream 4 will develop a framework to help improve services for frequent users. 


Our findings will enable Urgency and Emergency Care networks to make informed planning choices about services for frequent users. We will provide best evidence on how interventions work (or fail) in order to guide on-the-ground delivery.