DISPELLING MYTHS ABOUT FREQUENT ED USERSCassandra BarrettNortheastern University

FactUninsured and privately insured

individuals have the same rates of frequent use (Zuckerman, 2004).

MythFrequent flyers in the ED

are mainly uninsured.

ADDITIONALLY, In the same study, publicly insured individuals

were shown to be 2.08 times more likely to become frequent ED users (Zuckerman, 2004).

Individuals lacking primary care are actually less likely to be frequent ED users (Hunt, 2006).

Myth Frequent ED users

don’t usually need to be in an acute care

setting. Fact

Frequent users are admitted to the hospital at a rate of 51%, are more likely to be transported by ambulance, and have

greater mortality rates associated with their ED visits (Rabin, 2010).

MythFrequent ED users

“did it to themselves.”

Fact A study of frequent users in urban EDs

proved that risk factors are associated with socioeconomic distress, chronic illness,

and high use of other health resources (Sun, 2008).

MythIndividuals who

overuse the ED do so because they do not know that there are other alternatives. Fact

Frequent ED users rely heavily on other parts of the healthcare system as well, and are more likely to have made more primary care visits than occasional users in the same year (Rabin, 2010).

ADDITIONALLY, A risk factor for frequent ED use

includes having had 5 or more outpatient visits within the year

93% of frequent ED users have a PCP (Rabin, 2010).

FactMany pilot programs have proven that

comprehensive follow up care improves return rates.

Myth follow-up care won’t

matter with this population, because they won’t keep their appointments, and

they’ll just come back.

FOR EXAMPLE, Intensive management has proven to not only

improve social and clinical outcomes for frequent users, but also to decrease ED costs (Althaus, 2011).

In one North Carolina Study, team-based, drop-in group medical appointments coupled with case management proved to be a cost-effective model of reducing ED visits in patients with complex behavioral health and medical needs. ED recurrence rates dropped 60%, and hospital charges

dropped 80% (Crane, 2012).

TO KEEP IN MIND

Patients come from many different places and situations; there may be underlying reasons why they return to emergency care. Are they able to cope with their illness? Do they understand their disease? Do they have the resources required to

maintain their care?

TO KEEP IN MIND

The best health choices and education are not always available to this population. Can they afford “healthy” life choices?

The ED is often viewed as a last resort, and these patients may feel as though the health care system has failed them. Do they view you as their last hope?

IN PRACTICE Strive to understand before making

inferences. Be as welcoming and calming as you can. Be patient, and responsive to their needs. Refer to organizations that are accessible

to them. Take time to thoroughly teach, and ensure

understanding of their care.

REFLECTIVE NOTEThis presentation is modeled as either a brief instructional class that employees in the ED would cycle through during the day, or something that could be displayed on a loop in the employee lounge. It is geared towards dispelling myths and stigmas about frequent ED users and the prejudices that may accompany the care of these individuals. The presentation will have the best impact when viewed full-screen with animations. The myth/fact design aspect is meant to simplify the format and delivery of information as well as capture the viewer’s attention. It is additionally meant as a tool to show ED practitioners real-life data about this population, and remind them how to act towards these patients.I wanted to use some of the myths that I have observed in my experience working in the ED, and find research to dispel some of these negative ideas. This presentation could additionally serve as a discussion topic that could even spearhead interventions to improve ED services in the future. This would work well in my portfolio, as it would be a great item to showcase my writing as something that potentially could be useful in this field.

ReferencesAlthaus, F., Paroz, S., Hugli, O., Ghali, W.A., Daeppen, J.B.,Peytremann-Bridevaux,I., Bodenmann, P. (2011).

Effectiveness of Interventions Targeting Frequent Users of Emergency Departments: A Systematic Review. Annals of Emergency Medicine, 58 (1). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/21689565

Crane, S., Collins, L., Hall, J., Rochester, D., Patch, S. (2012). Reducing Utilization by Uninsured Frequent Users of the Emergency Department: Combining Case Management and Drop-in Group Medical Appointments. Journal of the American Board of Family Medicine, 25 (2). 184-91. Retrieved from: http://www.jabfm.org.ezproxy.neu.edu/content/25/2/184

Hunt, K.A., Weber, E.J., Showstack, J.A., Colby, D.C., Callaham, M.L. (2006). Characteristics of Frequent Users of Emergency Departments. Annals of Emergency Medicine, 48 (1). Retrieved from: http://www.mdconsult.com.ezproxy.neu.edu/das/article/body/419061605-4/jorg=journal&source=&sp=16280334&sid=0/N/538009/1.html?issn=0196-0644

LaCalle, E., Rabin, E. (2010). Frequent users of emergency departments; the myths, the data, and the policy implications.Annals of Emergency Medicine, 56 (1). Retrieved from: http://ehis.ebscohost.com.ezproxy.neu.edu/ehost/detail?sid=544c56cd-dc8e-4898-af52-d6d99d3d6d98%40sessionmgr104&vid=1&hid=102&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=rzh&AN=2010718209

Sun, B.C., Burstin, H.R., Brennan, T.A. Predictors and Outcomes of Frequent Emergency Department Users. Academic Emergency Medicine, 10 (4). 320-28. Retrieved from: http://onlinelibrary.wiley.com.ezproxy.neu.edu/doi/10.1111/j.1553-2712.2003.tb01344.x/abstract

Zuckerman, S., Shen, Y. (2004).Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter? Medical Care, 42 (2). 176-82. Retrieved from: http://ehis.ebscohost.com.ezproxy.neu.edu/ehost/detail?sid=fcb7bba8-6cbf-4ba0-928c-ebe7dd47e89f%40sessionmgr111&vid=1&hid=102&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=rzh&AN=2004163649

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