Frequent Flyers in the Emergency Department

We’re all aware of the patients that are seen in the ED so frequently that the ER staff know their names, medical histories, and sometimes family members very well. They are the so-called “frequent flyers.” These patients have been characterized as uninsured and on occasion, undesirable.

A recent study analyzed 25 studies done in the last decade detailing the characteristics of these patients. As usual, reality is different that perception.

The study examined data from a variety of sources. The bulk of these studies examined patients being treated at university of public hospitals. Some highlights:

  • 1 in 20 ED patients were “frequent fliers”, and they accounted for more than a quarter of all ED visits. Many go on to become a frequent flyer the following year, too.
  • Half of frequent flyers presented to multiple EDs
  • The majority (60%) were middle-aged and white
  • Almost two-thirds had Medicare or Medicaid coverage. Only 15% were uninsured.
  • Frequent users were more likely to have seen a primary care physician in the year before their visits. They were also 6 times more likely to have been hospitalized after a visit.
  • Use of ambulances was more frequent, and mortality was higher.
  • Children were frequent flyers, too. Parents stated that access to a pediatrician was the major factor, but 95% of kids had a primary care provider.

Hopefully, this study will stimulate more scrutiny of this patient group. The research may give some insight into some of the unintended consequences of healthcare reform.

Reference: LaCalle, Rabin. Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications. Ann Emerg Med, in press, March 2010.

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