Studies: Frequent Users of the ER — NOT “Abusers” of the System
DENVER — “Frequent flyers,” or frequent users of the emergency department, do not have higher rates of non-urgent visits than typical ER patients, according to several new studies released today at a scientific meeting of the American College of Emergency Physicians (ACEP). Despite being demonized as abusers of the health care system, the studies find that frequent users represent a small percentage of the total number of emergency patients and that most seek emergency care appropriately.
“Frequent users are equally justified in seeking emergency care as non-frequent users because they have serious medical problems that demand emergency care,” said Andy Sama, MD, FACEP, ACEP’s president. “If one certainty emerges here, it is that patients with mental illnesses and psychiatric emergencies are coming to the ER because other resources are simply not available to them. Frequent users are also more likely to be insured by Medicare or Medicaid and to be chronically ill.”
The definition of “frequent user” varies widely, from a patient who visits the emergency department four times a year to one who is there more than seven times a year. They are responsible for anywhere from 11.5 percent to 39.7 percent of all ER visits, depending on the definition of frequent user.
Studies in both Virginia and Wisconsin found that patients who visit the emergency department frequently do so for a relatively brief period – only a year or two. Results were mixed on whether frequent users were more or less likely to be admitted to the hospital from the ER. However, high repeat users in a Virginia emergency department, once admitted to the hospital, were significantly more likely to be re-admitted after 30 days.
Robert E. O’Connor, MD, MPH, FACEP, one of the study authors from Virginia, noted that “federal programs designed to penalize providers for 30-day readmissions may be dangerous for high-risk patient populations. Our data show that patients who were frequent users of emergency department services following hospital discharge were more likely to require readmission for unstable health conditions that could not be managed in an ambulatory setting.”
Repeat users, when defined as having two or more visits in a six-month period, represented 19.7 percent of all patients and 39.7 percent of all visits to the Virginia ER. In this study, patients who visited most often – more than nine visits in a 6-month period – represented less than 2 percent of all emergency department visits. These patients were more likely to be on Medicare and had significantly greater odds of having psychiatric illnesses.
In Massachusetts, frequent users were defined as patients who visited the emergency department five or more times in a year. They represented 2.1 percent of patients and 11.5 percent of visits. Like their counterparts in Virginia, they were more likely to be on Medicare and more likely to have mental illness-related visits.
So-called “super users,” defined as patients who visit the ER 21 or more times in a year, in California were more likely to visit multiple hospitals for care. Although they represented only 0.2 percent of all patients, they accounted for 4.5 percent of all emergency department visits in the region. Frequent psychiatric patients in the California study were also more likely to visit multiple hospitals for care.
“Emergency departments are the safety net for everyone, especially these most vulnerable patients,” said Dr. Sama. “When appropriate, emergency physicians work to obtain better outpatient access to resources in their community for these patients. But very often we provide the care they can’t get anywhere else. We treat these and all of our emergency patients for just 2 cents out of every health care dollar.”
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
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