This project has now closed but you may find the below resources useful. Please note the information on this webpage was correct at the time of publication.

The SHarED (Supporting High impact users in Emergency Departments) project aimed to improve outcomes for the most frequent users of Emergency Departments (EDs). The model was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years. The UHBW project has had success in reducing attendances to the Emergency Department (ED), whilst supporting users to seek healthcare and support in a more appropriate way.

Evaluating SHarED – a positive impact on patients and staff:

The evaluation of the SHarED project, undertaken by NIHR ARC West and published in April 2023, demonstrates:

  • 148 High Impact Users (HIU) have been engaged across the six adopting EDs
  • 33% reduction in HIU ED attendance in six months before and after taking part in SHarED
  • 67% reduction in HIU hospital admissions in six months before and after taking part in SHarED
  • over 360 staff were trained to support HIUs
  • There were improvements in ED staff feelings of confidence, support and training, and a perception that HIUs were receiving more appropriate care.

Read our summary infographic which highlights key project information and evaluation findings.

Read the full pre-print study of the SHarED evaluation.

Read our news story and Plain English summary of the evaluation.

Read our project impact case study.

How did SHarED start?

In 2019, Dr Becky Thorpe of UHBW put forward SHarED for our Evidence into Practice Challenge. Read more about the Evidence into Practice challenge. It was one of two programmes selected for adoption and spread across the West of England. We worked collaboratively with the UHBW team to spread SHarED to all six EDs in the region. There was an active Project Steering Board and all acute Trusts in the region have been involved in this improvement work.

Watch our introduction to SHarED video:

Why is SHarED necessary?

HIUs are defined as those who attend the Emergency Department (ED) more than five times per year. HIUs of UK EDs suffer severe health inequalities and, in England, represent 2% of attendees but account for 11% of attendances. They experience exceptionally high rates of mental health problems, learning disability, homelessness, substance misuse, domestic abuse, safeguarding concerns and are often from an ethnic minority background. They often attend the ED as they have nowhere else to go.

What was the SHarED approach?

The SHarED project aimed to provide complete parity of esteem for all patients in the ED through delivery of the personal support plans. The plans were co-created by HIU co-ordinators and other relevant professionals from the multidisciplinary team. The team worked with 10 HIUs at any one time with new individuals being selected through a locally developed triaging tool. View the resources for implementation of SHarED.

Hear more about SHarED and how the model can reduce readmission rates in high impact users, in this short video:

Find out more about SHarED by reading a blog ‘High impact users – changing the culture’ from Sally Buckland, High Impact Unit Team Lead, Bristol Royal Infirmary.

Explore the SHarED Implementation Guide and resources

SHarED Implementation Guide

Resources for implementing SHarED

These resources support the implementation of a High Impact User Team and give advice and guidance on achieving successful SHarED implementation in your emergency department.

View the resources