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Frequent Visitors in the ED, CT ACEP 2019
- 1. FREQUENT VISITORS IN THE ED PERCEPTIONS OF FREQUENT VISITORS AND USE OF THE ED TRACK BOARD ICON
- 2. SPLIT FLOW: FREQUENT FLYER, NO ONE IS PICKING UP THE PATIENT
- 4. WHO ARE FREQUENT VISITORS? β’ Usually defined 4+ ED visits/year β’ 4-8% of ED pt, yet 25-30% of annual visits β’ Labelled inappropriate users of ED β’ Compared to avg ED pt, more likely β’ To be sick: β’ Higher adjusted mortality rates β’ Have chronic medical problems β’ Have urgent conditions β’ Already medically connected β’ Have PCP- and make apts β’ Have insurance β’ High levels care outside ED
- 5. METHODS β’ Sent to Bridgeport, YNHH ED staff β’ Identify track board icons β’ Report usefulness of icons β’ Perceptions of FV β’ Burnout- 2 items from MBI depersonalization & emotional exhaustion
- 6. RESULTS β’ 148 providers completed (residents, attendings, APP, nurses) β’ Many providers thought FV would be less sick, nurses more than residents (52% vs 39%). β’ Consistent with popular misconceptions, avg provider thought FV was less likely to have PCP, less likely to have insurance β’ On avg, there was less of urgency for FV, they were slightly less likely to urgently need to be seen, require labs/ imaging or admission 0 10 20 30 40 50 60 70 80 90 100 Biohazard Call-in Panic Frequent Visitor Percent of Track Board Icon Correctly Identified Percent Correctly ID
- 7. BURNOUT CORRELATED WITH NEGATIVE VIEWS OF FREQUENT VISITORS β’ Nurses that were more burned out perceived FV as significantly more uncooperative, 0.91 points (95% CI 0.2 - 1.6) β’ Only 15% of nurses believed the icon might negatively impact their treatment.
- 8. CONCLUSIONS β’ Correct identification of track board icons is mediocre β’ Why are they cluttering out view? β’ ED providers believe frequent visitors to be healthier and less compliant than they are β’ Then why are they flagged with icons that may bias their view? β’ More negative perceptions held by nurses, particularly those that are more burned out β’ Though few believed the icons would affect their care
- 9. CITATIONS Bernstein, Steven L. "Frequent emergency department visitors: the end of inappropriateness." (2006): 18-20. Krieg, Cynthia, et al. "Individual predictors of frequent emergency department use: a scoping review." BMC health services research 16.1 (2016): 594. Sandoval E, Smith S, Walter J, et al. A comparison of frequent and infrequent visitors to an urban emergency department. The Journal of Emergency Medicine. 2010;38(2):115-121. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8. Hansagi H, Olsson M, Sjoberg S, Tomson Y, Goransson S. Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med. 2001;37(6):561-567. Lucas RH, Sanford SM. An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med. 1998;32(5):563-568. Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med. 2006;48(1):9-16.