Research
Almost ‘like family’: Emergency nurses and ‘frequent flyers’*,**

https://doi.org/10.1016/S0099-1767(96)80102-4Get rights and content

Objective

Heavy users (HUs) of emergency services (“repeaters” or “frequent flyers”) are often regarded by emergency nurses as “problem patients.” Yet, these patients also solicit deeper clinician involvement because of their familiarity and their often intractable medical and social problems. The primary objective of this study was to contribute to improved understanding of the phenomenon of heavy ED use by describing the context within which such use occurs and its meanings to patients and to clinicians.

Methods

Observational and narrative data were collected during ethnographic fielwork in two inner-city trauma center emergency departments. Data were interpreted using interpretive phenomenological strategies.

Findings

Relationships between ED clinicians and HU patients in the study hospitals were characterized by complexity and ambivalence, but thematic analysis of interviews revealed commonalities. Recognition practices, discussed in this article, were central to both centers.

Discussion

Frustration with a system that focuses on control but often leaves ED clinicians feeling like failures as they try to pick up the pieces for failing or absent families, communities, and social programs can contribute to stigmatization of HU patients, missed clinical diagnoses, and reduced nurse morale. Acknowledging the reasonable limits of control, and engaging in simple recognition and inclusion practices, may be more meaningful in furthering changes in HU patient behavior than biomedically oriented interventions.

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Cited by (61)

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    This group was recognized early, though has had different labels through the years10; but no concerted, useful measures have been found for effective management. In addition to the medical complaints that never seem to end, and never seem to get better, it has been suggested that frequent, high utilizers of the ED establish a different relationship dynamic with members of the health care team and almost treat the ED environment, with all its harshness, as a support system and a home: thus, frequent flyers may cause frustration in providers at all levels, seem to have trouble relinquishing control, causing frustration with seemingly unsolvable problems.11 But frustration is not the only feeling that emerges in the clinician patient relationship in this setting: it is now more understood that there is much ambivalence mired in complexity in these cases, and grounding frequent flyers is better than dismissing or abandoning them.12

  • Cost-effective: Emergency department care coordination with a regional hospital information system

    2014, Journal of Emergency Medicine
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    Frequent ED users tend to be a complex low-income population in poor physical health, with many suffering from mental illness or substance-use disorders (1,3,13–17). Resources consumed by this group are vast, and concomitant with an increased frequency of ED visits is ED crowding, wait times, strain on staff, and adverse outcomes (15,18–28). Therefore, helping these patients get the care they need in the appropriate setting is crucial.

  • Care plan program reduces the number of visits for challenging psychiatric patients in the ED

    2012, American Journal of Emergency Medicine
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    Emergency departments (ED) in the United States have experienced a 32% increase in number of visits between 1996 and 2006 [1]. A small group of patients use a large, disproportionate amount of ED resources [2,3] for medical, social, and psychiatric reasons [4-7]. Emergency department visits for primary mental health concerns increased by 40% between 1992 and 2000 [8], and psychiatric conditions have been shown to influence frequency of ED use [9-11], and evaluation of repeat visits to the ED is an important quality improvement tool [12-14].

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*

Supported by grant No. R03 HS08412 from the Agency for Health Care Policy and Research (AHCPR). Additional funding was provided by the Regents of the University of California; Nurses' Educational Funds, Inc.; Sigma Theta Tau, Alpha Eta Chapter; Graduate Research Award, University of California, San Francisco; and the Alameda County Nurses' Association.

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