Perspectives of patients who frequently attend the emergency departments in Australia’s Northern Territory: a phenomenological inquiry

Health facilities in the Northern Territory (NT) of Australia service a culturally diverse population, with 26% identifying as First Nations people compared with 3.2% nationally. Frequent emergency department (ED) attendance is often by individuals with high levels of disadvantage who face challenges accessing care that appropriately meets their needs. This study explores the perspectives of people with lived experience of frequent ED attendance, with the aim of informing strategies to enhance service delivery for this complex population. An interpretive phenomenological approach was used, with vignettes describing typical ED presentations used to stimulate discussion. Participants were encouraged to share personal experiences and understandings of the scenarios with First Nations researchers and a non-First Nations researcher. Sessions were audio recorded, transcribed verbatim and analysed by inductive and deductive coding. A total of five (5) participants, four (4) of which identified as First Nations people, provided perspectives of frequent attendance. Findings were grouped across four points in the ED journey: deciding to attend, waiting, being inside the ED, and discharge. Participants described a reluctance to attend the ED, doing so only when no other options were available. Their complex living circumstances with an interplay of social, economic, and environmental factors impacted their capacity to prioritise health, which in turn contributed to suboptimal care in ED. Recommendations for improving service delivery included workforce development, understanding the importance of family relationships, and enhanced communication and understanding of decision-making needs through a cultural lens. As a single point of contact, a care navigator could improve outcomes by creating a safe space to explore individual needs, streamline links with community based social services, minimise the fear of health services, and facilitate care solutions that are sustainable and achievable.