BOSTON—The onus of reducing superutilizers in emergency departments is on a lot of people. Politicians. Health care advocates. Hospital administrators. So why are emergency physicians so well-positioned to take the reins?
“We are the hub of all of medicine,” Stephen Anderson, MD, FACEP, an emergency physician in Seattle and a member of ACEP’s Board of Directors, said at ACEP15 on Wednesday. “A day doesn’t go by—I guarantee you—that you don’t hear from someone in mental health sending you somebody. Someone from the urgent care that can’t do the workup is sending it to you. The pain center that the patient can’t get into. So where do they come? They come to you.
“We’re being asked not only now to accept all these into [the ED]. Our job now is to communicate back to all of these and close the loop.”
Dr. Anderson was one of three panelists presenting “Coordination of Care Through the ED: Influencing Costs, Recidivism and Health Outcomes.” The Colin C. Rorrie Jr. Lecture’s other presenters were Chad Kessler, MD, MHPE, FACEP, deputy chief of staff at the Durham VA Medical Center in North Carolina, and Maria Raven, MD, MPH, FACEP, of the University of California, San Francisco.
The annual policy presentation challenged emergency physicians to tackle the problem of superutilizers, more commonly dubbed frequent fliers, at their institutions. The challenges are many—lack of community resources, complicating comorbidities, and some patients’ underlying drug/alcohol issues—but the sometimes-proffered solution of blocking ED access is not the answer, said Dr. Raven.
“There’s no way at this point to safely identify in advance who does and does not need to be at your door,” she said. “Everyone may think that there’s some tool that can help you get there, but it actually doesn’t exist.”
Once the patient is in the door, though, there are tools. In Dr. Anderson’s home state of Washington, an Emergency Department Information Exchange (EDIE) was created in recent years to help address superutilizers and lower care delivery costs.
“When you check into an emergency department in Washington, before anything else happens, your name gets sent up to the cloud,” Dr. Anderson said. “We match your demographics and even before [the physician goes] in to do your medical screening exam, you have sitting in front of you…an emergency department alert, which is tied to a care coordinated plan across all emergency departments in the state.”