Frequent Flyers in the ED

Published

So...I think everyone has their frequent flyers crowding up the already overcrowded EDs across the country. I was wondering if anyone's ED came up with anything that works!!!

We have our usual drunks, of course. At least we finally got some of our EMS departments to NOT transport them in when they have NO c/o!!! We had one local PD who picked up one of chronics and arrested him with public intoxication. Of course, they didn't want to keep him so they bonded him out on a SIGNATURE bond (this is important now!) Then they called rescue to transport him to us...because he was too drunk to be decisional and let go.

Ok so he's decisional enough to SIGN a signature bond...but not to pass out in the confines of his own bed!!??!! Sorry...no such luck!

Anyway...I digress!

I was thinking really of the seekers. We tried to come up with protocols and contracts and care plans...no go. I really HATE being the best dealer in town.

Anyone with anything that works?

Specializes in ED, MS, CC.

I'm sorry I'm an ER nurse that occasionally experiances migraines. I have home meds and I have a primary care doctor to treat me. I am fortunate enough to work in the ER so if I have a headache that my home meds don't cure I can go to work if my primary or urgent care isn't open. I have to disagree about Toradol helping migraines. If 800 mg of IBU every 4- 6hours isn't helping-neither is toradol and I'm not seeking anything but RELIEF.

God save me from the judgemental nurse!

I don't work in the ED, only "floated" there a few times to help out. I say that because I don't know what it's like to experience the day in and day out seeker. It has to be frustrating.

I am, however, reminded of an experience I personally had. I have gotten headaches on occasion. Most of the time they were controlled with some aspirin or tylenol.

One day after working nights the night before, I started with a dull headache. I thought if I went to sleep it would go away.

It didn't...

To make a long story short, I ended up calling my neighbor to take me to the ER. (I couldn't hold my eyes open it hurt so bad)

Got to the ER and they had me wait. After two hours I ran vomiting, outside the building. My neighbor went to the desk and asked for a cold cloth for me and inquired about how long it might be until I could be seen. She was told that since I "left" the building, that I would have to re-register and that they couldn't give out thier linen to folks.

She came outside and led me to her car and took me to another ER. There, I was seen within a few minutes. The doctor actually asked me what medication I wanted! I told him at this point I just want something to make the nausea go away. He gave me phenergan and toradol. I went home with my friend/neighbor sleepy and feeling much better.

That was the last time I've had to use the ER for a headache, thank God!

I've learned from having that toradol that if I will hit ANY headache with ibuprophen EARLY, it will take care of it.

I can not imagine having to suffer with headaches like that one frequently.

It felt awful to be knowingly clustered into a "drug-seeking" label by that first hospital.

Specializes in ER/PICU.

We use care plans. Records are flagged both in the registration computer system with an automatic crossover to our electronic tracking board. Discrete identifier on the patient labels. Care plans are created in concert with primary physicians. Lacking a PMD the one of the ER physicians acts as the PMD for pain control issues. While we DO have some of the ED docs that do NOT follow the system, the majority follow them to the letter.

On another side of the fence, our care plans are also used for patients with unique medical conditions that require specific plans of care for their treatment. I also recall a recent letter submitted to the Journal of Emergency Nursing from Milwaukee that created a "Super User" program with almost all of the sister hospitals in the area with an actual sharing of care plans on a common data base.

Specializes in Cardiac, ER, ICU.

Our documentation system has a pull down menu where we can see all of their visits and notes from each visit after 2004. we have a FF who came here last night for her 37th visit in 2007, plus we found out about 16 visits to a hospital about 15 miles from here and some to the city hospital too. Her eyes got real big when we asked is this the same thing you were seen for 2 nights ago at CSH??

Then there is our funny FF who comes in with a non rebreather intact, sitting up on the stretcher gripping his travel mug, asking which doc is on. When he finds out he signs out AMA and returns at 0700 for the next doc. This guy is here at least once a week, sometimes more than once in 24 hours! He's always in agony.. and needs his dilaudinum. LOL he's so rediculous though that he is almsot cute.

Specializes in Cardiac, ER.

I think that some of you who are trying to defend the pt with the "real" migraine are maybe misunderstanding our definition of a frequent flyer. Someone that comes in 3-4 times a year is NOT a FF. I am not exaggerating a bit when I say we have people who come to the ER 80 or 90 times a year!! I don't care what your c/o is,.there is something way wrong with someone who spends that much time in an ER!!! The FF I is see may come in more than once a day. We have many employees that moonlight at another hosp in town and will see the same pt several times in one weekend at both hospitals!! These are people who will come in and start swearing at triage,.people who will often come back a few hours later with a sick "friend", people who are in car accidents at least once a month (severe back and neck pain) yet don't own a car and never have a ride home. I do understand that these people are sick,.but the ER is not the place to treat this sort of problem. The pt with a real migraine, or real back pain etc might need the ER for occasional pain control,.but that isn't the pt we're talking about.

Just a curious thought,.wonder why medicaid doesn't get involved with those pt's who have multiple visits to the ER in a short period of time? You would think if a pt is seen in the ER 40 times in 90 days and has not seen a PCP in that time, they would some how intervene. Just a thought.

Specializes in ER/EHR Trainer.

Migraine sufferers always get meds including iv fluids and iv reglan. Definately seems to work.

We've stopped giving iv meds to frequent fliers-(including adult SC), they get PO meds only. Just had one leave AMA recently. Unable to get a line anywhere due to former drug habit. His problem severe constipation-got a percocet-then pissed off-left. Proclaimed drug problem gone for 10 years-demeanor, dress, and attitude said otherwise.

We'll see how this works. We are also leaving them to their doctors-especially with admits. ER docs less likely to hit them up with heavy meds-their own must prescribe with parameters-it's amazing how our drug usage has gone down!

Maisy;)

+ Join the Discussion