Dispelling Myths about Frequent ED Users

1. Dispelling Myths about Frequent ED Users Cassandra Barrett Northeastern University

2. Myth Frequent flyers in the ED are mainly uninsured. Fact Uninsured and privately insured individuals have the same rates of frequent use (Zuckerman, 2004).

3. 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).

4. 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 greatermortalityrates associated with their ED visits (Rabin, 2010).

5. Myth Frequent ED users “did it to themselves.” Fact A study of frequent users in urban EDs proved that risk factors are associated with socioeconomicdistress, chronicillness, and highuse of other health resources (Sun, 2008).

6. Myth Individuals 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 primarycare visits than occasional users in the same year (Rabin, 2010).

7. 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).

8. Myth follow-up care won’t matter with this population, because they won’t keep their appointments, and they’ll just come back. Fact • Many pilot programs have proven that comprehensive follow up care improves return rates.

9. 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 medicalneeds. • ED recurrence rates dropped 60%, and hospital charges dropped 80% (Crane, 2012).

10. 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?

11. 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?

12. 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.

13. Reflective NOte This 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.

14. References Althaus, 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

15. Image References [Drawn image depicting uninsured man and hospital bill with printed lettering] Retrieved August 1, 2013, from: https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcSYMyC2qWgiQ6RLIiOfp3I1q_Ga0SeJ1VOlZffQF78uBVNuA7dMzg [Emergency room sign photograph] Retrieved August 1, 2013, from: http://idiopathicmedicine.files.wordpress.com/2011/01/emergency-room-sign.jpg Pascal, H. (blogger). The risk of unreliable information. [wordle], Retrieved August 1, 2013, from: http://www.riskinvietnam.com/wp-content/uploads/2012/05/unreliability2.jpg [Photograph of man eating raw meat] Retrieved August 1, 2013, from: http://ru.zemmrate.com/uploads/posts/2013-02/1360664598_1339416575_kotorye-vredny-dlya-muzhchin.jpg Rodrigo (cartoon artist). (2009). BlindHospitals. [cartoon drawing], Retrieved August 1, 2013, from: http://www.toonpool.com/user/1631/files/blind_hospitals_555915.jpg