Although many hospital administrators view patients who frequently turn up at the emergency room as a nuisance, new research shows that these "super-users" have unmet needs and are at a high risk of death compared to patients who don't usually seek emergency care.
The study, published online in the Emergency Medicine Journal, conducted a systemic review of 31 observational studies on the mortality and health outcomes of ER super-users compared to non-frequent users of the emergency department.
The studies used different definitions of what constituted frequent ED use, but the most common are those who visit the ER four or more times in a year.
The latest research shows that these patients, often referred to as "frequent fliers" are at increased risk of death, admissions per visit, admissions per patient and outpatient visits, according to author Jessica Moe, a resident in the emergency medicine resident program, Department of Emergency Medicine, University of Alberta, Edmondton, Alberta, and her team.
The findings indicate hospital leaders shouldn't view frequent users as inappropriate consumers of ED resources, according to the research team. "Clearly, to view frequent users as merely a nuisance or drain on resources represents a narrow, biased and potentially dangerous view of this issue," they write.
Instead, they suggest, providers should give these users focused attention and implement interventions designed to meet their unmet needs from practitioners, health administrators and policymakers.
ED super-users are high-risk patients who often have mental health and addiction issues; are homeless; or suffer from a chronic disease, such as heart failure or chronic obstructive pulmonary disease. Furthermore, many have conditions that require transient increased needs, such as missed diagnoses and complications. They need appropriate interventions and researchers noted that case management is helpful in many of these instances.
However, researchers urged the healthcare industry to first adopt a standardized definition for frequent ED use to determine who the superusers are, the nature of their increased clinical risk and which subgroups of frequent fliers could benefit most from targeted interventions.
- read the study
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