How EHRs can improve planning for emergency care 'frequent fliers'

Medicaid "frequent flier" patients to the emergency department have different characteristics than infrequent ED visitors, which call for different strategies, according to research published by Big Data.

The researchers used EHR records to comb through potential factors related to revisits within 72 hours among Medicaid patients at Albany (N.Y.) Medical Center over two years. From more than 15,000 factors, including primary and secondary ICD-9-CM codes, patient demographics and more, they selected 385 factors for statistical analysis.

The three factors making revisits more likely were alcoholism, living within ZIP codes with high revisit rates in close proximity to the hospital, and frequent use of the ED and hospital in the past six months.

Frequent fliers, they found, tend to have diagnoses related to alcohol, mental health, substance abuse, headaches, HIV disorders and back problems. Infrequent ED patients are more likely to have injuries, infections, fever of unknown origins and skin problems.

Coming in at night, being discharged between 4 and 8 a.m., and leaving against medical advice all carry higher risk of revisits. Infrequent visitors are more likely to be discharged to their homes, while frequent fliers are more likely to be discharged to psychiatric facilities.

Patients with past 72-hour revisits were three times more likely to return than infrequent patients.

Understanding these patterns of ED use can help healthcare organizations develop strategies to more effectively deal with the sub-populations they serve, the researchers say.

In a pilot project, Aurora Sinai Medical Center in Milwaukee, Wisconsin, identified a group of ED "super users" and employed social workers to help them get the ongoing care they need through a primary care doctor or clinic.

The city of Reno, Nevada, meanwhile, used a $9.8 million federal grant to overhaul its emergency services and trained paramedics to redirect certain patients to urgent care or mental health clinics. It also offers and a phone line run by nurses to answer callers' health questions as a 911 alternative. 

To learn more:
- read the research