"Frequent-flier" ED users take toll on emergency physicians

They often contribute to professional burnout and inspire less empathy than patients with true emergencies.

By Kevin B. O’Reilly — Posted June 17, 2011

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About 60% of emergency physicians say they have less empathy for so-called frequent-flier patients who visit the ED more than 10 times a year.

Nearly 80% told researchers they hold some bias against these patients, and 82% said caring for them contributes to their level of burnout, according to survey data presented at the Society for Academic Emergency Medicine's June annual meeting in Boston.

"The emergency room is becoming their primary source of care, and it's not any ER's goal to be an outpatient care provider. That's not the model of what the ER is supposed to be," said Jennifer Peltzer-Jones, PsyD, who led the survey team. "If you look at burnout, there's that lack of a sense of personal accomplishment. The ER model is you fix the patient and you get them out. If the patient keeps coming back for whatever social reasons or constraints, you can easily understand how ER physicians would not feel like they're accomplishing anything."

Nearly all the 418 emergency physicians surveyed said they treat patients who frequently use the ED, but only 30% reported working in a hospital that had a program dedicated to helping these repeat visitors avoid the emergency department. Such programs can help emergency physicians by addressing the problems that bring patients to the ED repeatedly, said Peltzer-Jones, clinical psychologist in the Dept. of Emergency Medicine at the Henry Ford Health System in Detroit.

In 2004, Henry Ford started Community Resources for Emergency Department Overuse, a multidisciplinary program to identify patients who made dozens of ED visits annually. The program created individualized care plans for the patients and helped them connect with a primary care physician.

Between 2005 and 2007, the program helped slash ED charges 24% among the 36 patients enrolled, from $64,721 to $49,208, according to a September 2010 study in the Western Journal of Emergency Medicine (link). The number of lab studies ordered for patients in the program fell by 28%, from 1,847 to 1,328. The average number of visits per patient during the period was cut by 25%.

In lieu of such programs, it is not clear that the loss of empathy toward frequent ED users affects care quality, Peltzer-Jones said. Emergency physicians appear to be aware of their feelings and treat patients in a professional manner.

"You don't always have to love every patient you're giving care to," she said. "If you're not aware of it, you don't know how it's going to affect you. ... The ER physician being aware of knowing that this is a difficult patient to treat is very important."

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