How to recognize a Frequent Flyer

[EmerNurse]

We were talking about this at work a couple days ago...

1. They ask for socks the moment they come back... and they're wearing the ones you gave them 2 days ago.

2. They list the ER docs name on the registration under "primary physician".

3. You can list their allergies FOR them when they come in.

4. The only order the doc gives you is "let's do the same thing we did last time... it worked." And it does.

5. They ask which doc is "on" before they sign in.

6. They're hollaring "I have a right to be here!" (not in your language either) - as they're rolling in the door on a stretcher.

I'm sure there's more out there...

[Altra, BSN, RN]

When you know the pt.'s social hx so well that you're aware that the reason the pt. is showing up intoxicated twice a week is because her significant other (also a FF) is currently in jail and she's out of her normal routine ... then you know you've got a FF.

[rn/writer, RN]

There are FF's who are abusing the system, and then there are FF's who really need to be there.

One of my grandsons has spina bifida and his mom certainly knows her way around the ER. She also knows which nurses and residents will work with her and respect her assessment on her kid (she's never once been wrong when she thought he needed a shunt revision), and which ones are going to give her an initial run-around because they know far less about spina bifida than she does. His old charts could fill a milk crate. He's only ten but he's had more than three dozen surgeries. The last time he was inpatient, he inserted his own NG tube with the nurse standing by. He's an amazing kid.

I've often thought the hospital should have an advocate for necessary FF's so they can keep certain info on file (and not have to reinvent the wheel with every admission). There would be easy access to old charts. And they could get a fast track to admission when that is needed, instead of waiting six hours for the obvious.

As for the elective FF's, they know which tests go with which maladies and can request certain labs or other diagnostic tools.

Of course, my daughter would do that, too.

Have to take a reading on your gut radar sometimes, to get a feel for which kind of FF you're looking at. Even then, you might end up doing the exact same thing. Such is life.

[Altra, BSN, RN]

There are FF's who are abusing the system, and then there are FF's who really need to be there.

...

I've often thought the hospital should have an advocate for necessary FF's so they can keep certain info on file (and not have to reinvent the wheel with every admission). There would be easy access to old charts. And they could get a fast track to admission when that is needed, instead of waiting six hours for the obvious.

You raise an excellent point, rn/writer. JMO, but I feel that what FFs of the chronic illness/exacerbation variety need is direct admission to the hospital, not ER visits. That would be advocacy at its best.

[canoehead, BSN, RN]

PC police- I believe it's obvious we are talking about FF that are not actually sick (usually).

[rn/writer, RN]

PC police- I believe it's obvious we are talking about FF that are not actually sick (usually).

Not necessarily. FF's come in many different flavors. Some are abusers of the system and have a huge menu of scams and strategies. Some are desperately/chronically ill and have learned to "work the system" as a matter of survival.

There can be considerable overlap between the groups. And you can't always tell which is which.

It isn't falling for the PC line to recognize that the chronically ill have some interesting parallels to the attention seekers and vice versa. Everyone does what they think they need to do to get by.

Meanwhile, we just keep on keeping on and try to stay sane enough to drive home at the end of the shift.

[Spidey's mom, ADN, BSN, RN]

Not necessarily. FF's come in many different flavors. Some are abusers of the system and have a huge menu of scams and strategies. Some are desperately/chronically ill and have learned to "work the system" as a matter of survival.

There can be considerable overlap between the groups. And you can't always tell which is which.

It isn't falling for the PC line to recognize that the chronically ill have some interesting parallels to the attention seekers and vice versa. Everyone does what they think they need to do to get by.

Meanwhile, we just keep on keeping on and try to stay sane enough to drive home at the end of the shift.

Good points.

I really like the idea of a way to advocate for patients like your grandson. My niece has spina bifida too and is well acquainted with the ER.

One nice thing about where I live is that it is rural and we know almost everyone even without ER visits.

steph

[mdoze911nurse]

while counting meds a certain narcotic had decreased in number by 2 vials and i said, "oh, _________ must have been here today" one of the student nurses was standing nearby and said, "oh, m, you have been here way too long when you know who's been in the er by the meds used." i told her it is just a trick of the trade since we spend more holidays with these folks than we do with our family, regardless of the reason they are ff.

i have decided that you have the really sick ff that need us not by choice but by illness, then you have the drug seekers that are allergic to every non-narcotic known to man and then you have the ones that the drugs can not possibly effect but still come from some psychological need to be filled. i think the last group is just too sad.

such is the life in the er but i would never trade it for the world. every once in a awhile a non-ill ff comes in and has a real problem. it is at that time that i remember to stay awake and alert!!!

[teeituptom, BSN, RN]

because I am on a first name basis with all of them

[LeesieBug]

They chase after you in Wal-Mart to chat, then when they can't catch you as you dive behind the potato chip rack to hide, they mention at the next ER visit "HEY, I saw you at the store the other day, but you didn't see me!"

I avoid our town's Wally World at all costs since I started ER.

They climb into the stretcher,reach their hand up behind them without looking and adjust the head of the bed, smooth as silk.

(and yes, I am referring to FF's who are NOT sick. NO problem with running into pts who were actually ill and not abusing ER. LOVE to hear updates and see them up-and-about, doing well. :)

[LeesieBug]

You mean to say there are people out there who use the ED like a clinic and state their PCP is one of your ED docs?

:chuckle

[anonymurse]

Not to thoroughly screw up a pretty decent humor thread, but . . .

My wife was a FF, had to keep coming back to OB for tocolytics for our second child as our firstborn arrived definitely not yet ready for prime time, but they treated her as a first-timer every time. Way it oughtta be in my book. Every patient deserves a fresh look every visit.

As for drug seeking, there was a CA pt in clinicals that everyone had pegged because they didn't feel her CA warranted it, going nicely into remission as it was. I was there when the oncologist went ballistic 'cause the radiologist failed to compare an abdominal CT with a previous one as ordered, and the next day we had our comparison and what do you know, kidney stones. Since that day, "drug seeking" hasn't been in my working vocabulary.

[Spidey's mom, ADN, BSN, RN]

I don't know what you guys are talking about...every patient I see in my dept. is a new very sick person who needs to come to the ED via ambulance for "burning while I pee".

You mean to say there are people out there who use the ED like a clinic and state their PCP is one of your ED docs?

Yes, actually all our ER docs have private practices and all of our patients have one of them as their pcp. Unless the patient is from out of town.

steph