High Intensity Users: A chart audit of multiple presentations to a paediatric emergency department

Ms Jaime Odonovan1

1Lady Cilento Children’s Hospital, South Brisbane, Australia


High intensity users impact waiting times and the efficacy of Emergency Departments (ED) and have a flow on effect on the functioning and resource use of the entire hospital. There is an absence in the literature regarding the causes as to why there are multiple and avoidable presentations to a paediatric tertiary hospital.  Literature in the wider ED research demonstrates that there are identifiable reasons on the impact of these presentations. This innovative study is the first known study to identify populations and causes for these presentations and level of social worker (SW) intervention.


461 patients were coded, based on their triage notes, into ten categories.  A retrospective chart audit was completed for patients who met the inclusion criteria to identify triggers for presentation and the SW interventions that were provided. 10% of the charts were peer reviewed.


37 patients charts were reviewed, which resulted in 415 presentations to the ED. Despite the high indicators of psychosocial dysfunction/concerns only 6% of presentations resulted in a referral to SW. The primary reason SW were referred was for discharge planning/youth homelessness. SW were rarely engaged for significantly distressed or anxious parents even though this is a key indicator for representation.


There are four identified themes that require further examination in the ED that potentially could change presentations and reduction of resources in the ED.  Medical processes/procedures, vulnerable populations, mental health issues and parental coping and anxiety were the themes contributing to high intensity users presenting to the ED.


Jaime O’donovan is a Senior Social Worker at the Lady Cilento Children’s Hospital

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

Conference Managers

Please contact the team at Conference Design with any questions regarding the conference.

Photo Credits: Tourism & Events Queensland

© 2017 Conference Design Pty Ltd