Frequent Flyers
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This is a discussion on Frequent Flyers in Emergency Nursing, part of Nursing Specialties ... A debate in class the other day made me think and justed wanted to get a broader opinion. How as...
by RustyMedic Apr 27, '12A debate in class the other day made me think and justed wanted to get a broader opinion.
How as Nurses can we curb, what those in the emergengy deparmet/medicine have coined, "frequent flyer's" or those that abuse the system? Or is that out of our control?
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Apr 27, '12 by VICEDRNI saw a recent article about how hospitals in washington started to address their frequent flyer problem after the state legislature was considering a law to limit medicare patients to 3 visits a year.
They used all of the stuff we are supposed to use but never do...social work and care plans to address these patients. In the article, the hospitals said...it worked.
It turns out that all it requires is being polite but firm and developing a thorough care plan to force these patients out of our waiting rooms.
I have always suspected that this was the case. Many of the frequent flyers are here because they get something in particular.
There is the guy who gets his vicodin refill once a month. (Stop giving it to him and send him to ortho clinic). The homeless people who sleep in the waiting room. (Have them greeted at the door by the ER doc, cleared and sent back out the door, taking away the incentive to do it.) The chronic "I need urine preg"/std check. (Do aggressive medical screening exams and be honest about ridding us of these folks regardless of whether they can pay or not.)NO50FRANNY and rgroyer1RNBSN like this. -
Apr 27, '12 by rgroyer1RNBSNQuote from VICEDRNTotally agreed, alot of the ff's could also use refferals for drug rehab as well since so many are hooked on opiates and benzos, and they wonder why they are sick so much, well buddy its all the crap you put on your body, not to mention addicts are sicker all the time because it knocks your defense sustems down, so addicts tend to be ill more then usual. And as far as the preg. tests people go give them refferals to the dollar store or free clinic.Rod, RN, BSNI saw a recent article about how hospitals in washington started to address their frequent flyer problem after the state legislature was considering a law to limit medicare patients to 3 visits a year. They used all of the stuff we are supposed to use but never do...social work and care plans to address these patients. In the article, the hospitals said...it worked. It turns out that all it requires is being polite but firm and developing a thorough care plan to force these patients out of our waiting rooms. I have always suspected that this was the case. Many of the frequent flyers are here because they get something in particular. There is the guy who gets his vicodin refill once a month. (Stop giving it to him and send him to ortho clinic). The homeless people who sleep in the waiting room. (Have them greeted at the door by the ER doc, cleared and sent back out the door, taking away the incentive to do it.) The chronic "I need urine preg"/std check. (Do aggressive medical screening exams and be honest about ridding us of these folks regardless of whether they can pay or not.) -
Apr 27, '12 by NO50FRANNYQuote from VICEDRNA similar pathway was recently developed in a tertiary hospital in South Australia with excellent results. Similar principles, social work, case workers, primary care and a defined pathway with rules and management plans individulised. Largely the frequent presenters stopped presenting at all. It was a huge relief to an already under-resourced ambulance service and ED.I saw a recent article about how hospitals in washington started to address their frequent flyer problem after the state legislature was considering a law to limit medicare patients to 3 visits a year.
They used all of the stuff we are supposed to use but never do...social work and care plans to address these patients. In the article, the hospitals said...it worked.
It turns out that all it requires is being polite but firm and developing a thorough care plan to force these patients out of our waiting rooms.
I have always suspected that this was the case. Many of the frequent flyers are here because they get something in particular.
There is the guy who gets his vicodin refill once a month. (Stop giving it to him and send him to ortho clinic). The homeless people who sleep in the waiting room. (Have them greeted at the door by the ER doc, cleared and sent back out the door, taking away the incentive to do it.) The chronic "I need urine preg"/std check. (Do aggressive medical screening exams and be honest about ridding us of these folks regardless of whether they can pay or not.) -
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Apr 27, '12 by ~*Stargazer*~Fliers.
The Washington State limit on ED visits paid for by Medicaid was suspended by that State's Governor, and has not taken effect. There were some legitimate concerns raised by Washington emergency physicians.
As individual nurses, it's not really our job to curb excessive/unnecessary ED visits. I think that, as a society, we need to address the root causes of this, such as lack of access to primary care. I recently read somewhere that the average wait time, nationwide, to see a PCP is 20 days. - Apr 29, '12 by JDougRNI just came to this thread, and I'm so upset right now- I just had a youngish guy come in- CC was ? Kidney stone vs UTI/ possible renal colic- He asked me if he should be seen here in the ED, or wait to 0800 to go to Urgent care, as he didn't have any insurance. I gave him the standard "We can't tell you not to stay" line, and he decided to go to UC. I begged him to make sure he follows up. Next pt. was a FREQUET flier- not quite homeless, but close to it- came in 116 times over the last 12 months- always by ambulance, paid by our tax dollars. Always chronic back pain- just looking for coffee and a turkey sandwich, plus every once in a while he might luck out and get a new provider who doesn't know him, and just might score the Lortab. He routinely gets scripts for Ultram that he throws away on the way out the door. We have to have Security watch him, because he knows his way around the hospital, and will stael anything that isn't nailed down. He goes to the other area hospital as often as he comes to us. HOW IS IT that we as healthcare workers can't report this putz, and get his funding yanked? How is there NOT a cap on costs? If I actually WORK for a living, I can and do have a 1 million dollar insurance cap on my health insurance, but this one person can abuse the system like this? I am looking at him, sitting in registration right now, watching him DEMAND the secretary call him a medicaid cab. I'm so ready to smack him.
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Apr 29, '12 by thelema13Quote from JDougRNI'm so ready to smack him.
Sometimes you wish no one was looking......
I get sick of seeing wasted resources. EMS brings in 'my elbow feel funny' and 'I might be pregnant, either 5 weeks or 5 months, you know, new boyfriends' and 'I have body aches and sniffles and a cough' and you know we pay for it out of our tax dollars. Not to mention 8 ambulances for a population of ~25,000, they really need to pick these people up when there are people dying elsewhere.
I had a guy come in tonight with a sore throat, pain 10/10. This 46 yr old was literally crying (when did adults start acting like kids? Grow the F up). Didn't want to go to his PCP cause "it's too expensive" and no urgent care clinic because "It costs about $200 to walk in the door and get a shot!" I ask, "you know your ED bill will probably be over $1000 dollars right?" He says "oh that's okay."
Common sense is not common......Last edit by thelema13 on Apr 29, '12 : Reason: spelling - Apr 29, '12 by ~*Stargazer*~Quote from JDougRNBecause this putz could actually present with a life threatening illness or injury that requires emergency medical intervention.HOW IS IT that we as healthcare workers can't report this putz, and get his funding yanked?
I know how infuriating these kinds of people are, believe me. But, when we start deciding who deserves medical treatment and who doesn't, we are on a very slippery slope.
What could help with someone like this is to implement a system in your ED where you use care managers to help establish care plans for frequent users of resources. This person's medical record is flagged so that whenever they present, their care plan pops up in the system.sauconyrunner and brainkandy87 like this. - Apr 29, '12 by JDougRNQuote from ~*Stargazer*~Honestly? I hear what you are saying, but come on? How about all of the ppl who can't get medical help, becaus ethe funding isn't there, because of people like him? This should be illegal, and this man should be told if he insists on stealing from society like he does, he will be charged with Grand Larceny. It's disgusting.Because this putz could actually present with a life threatening illness or injury that requires emergency medical intervention.
I know how infuriating these kinds of people are, believe me. But, when we start deciding who deserves medical treatment and who doesn't, we are on a very slippery slope.
