Two Ways to Deal with ED "Frequent Flyers"

A hospital in Maryland has come up with a novel solution for patients who are “frequent flyers,” politically correctly termed “super utilizers,” in its emergency room.

After identifying 318 people who visited the emergency department four or more times in 4 months, Sinai Hospital referred them to primary care doctors, social services, mental health and substance abuse programs, and insurance providers.

One young man who made eight trips to the emergency department in 4 months, often by ambulance, was assigned to a care coordinator who worked with him to arrange his medical care and deal with his nutritional, social, and economic problems.

The project, detailed in a recent Baltimore Sun article, cost the state $800,000 over 3 years. But it has resulted in 1000 fewer emergency department visits and paid for itself. In fact, the patient described above has not felt the need to visit the emergency department once since he enrolled in the program.

A few other hospitals in Maryland have seen similar results, although each hospital has unique issues. Some have discovered that the patients have a more pressing need for social interventions than medical care.

Because they save money in the long run and the patients are healthier, the hospitals are not losing revenue with fewer emergency visits.

A doctor in Japan took a more direct approach.

According to Asian media outlet Rocket News, a man with elbow pain was seen in the emergency department of Mutsu City General Hospital. He was treated and released, but showed up a few hours later with abdominal pain. He was again examined and discharged.

He returned a third time that night. When he became aware of the man’s presence again, a doctor entered his cubicle and punched him in the abdomen. The patient was not injured.

An investigation found the patient had been seen in the hospital’s emergency department 18 times in the first 8 months of 2015. On many occasions, “he was noticeably intoxicated and belligerent with staff.”

Most of the comments on the Japanese website originally reporting the incident were supportive of the doctor. They ranged from “That doctor is innocent. They should have arrested the patient” to “It would have been better if they just went ahead and euthanized the patient.”

The doctor apologized to the patient, and the hospital punished the doctor by giving him “a strict talking-to.”

I suspect the consequences for the doctor would have been a bit different had this occurred in here in the United States.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.