The Effects of Frequent Visitors and Over Usage of Emergency Departments

The emergency room in any hospital can be a saving grace to many of its visitors, treating patients for anything ranging from mild to moderate pain all the way up to acute bodily trauma.  Gone are the days where we call the emergency room as such.  It is now more appropriately referred to as an emergency department because, as most emergency department personnel so aptly point out, it is not just merely one room but a department comprised of many individual rooms consisting of a multitude specialized doctors working in unison.  The doctors servicing emergency departments have grown from just emergency medicine physicians to include general internists, critical care surgeons, and many other specialists that serve to combat even the most peculiar ailments.

Although the emergency department is such a positive entity, it is not immune to its own pitfalls and negative forces.  Emergency departments have to deal with sometimes incredible overcrowding which often results in equally as incredible wait times.  An emergency department also has the double-edged sword element of not being able to turn anyone away for any reason.  A physician examines every patient that visits an emergency department regardless of the reason for the visit.  Additionally, patients cannot be turned away for care whether the patient is able to pay his or her medical bills.

Perhaps the most critical aspect plaguing any emergency department is that of habitual visitors or “frequent flyers.”  A frequent flyer, in terms of an emergency department, is a patient characterized as someone who habitually seeks treatment at an emergency department.  One study conducted by the South Carolina Public Health Institute characterizes a frequent user as a patient who visits the emergency department at least five times in one calendar year in that state. The same study goes on to define a frequent user as a person of modest means and poor health, who goes in and out of emergency departments day after day.

In another study, conducted by the Washington State Department of Social & Health Services, examines Alcohol and Drug abusers and patients who have a mental illness that frequent emergency departments.  This study shows a higher incidence of visits among those patients that are categorized into these two segments who can be appropriately defined as substance abusers and those who suffer from some sort of mental illness.

Of all patients involved in this study that were considered frequent emergency department visitors, only 15% of them exhibited no indication of a mental illness or signs of drug and/or alcohol abuse.  In Contrast, of patients that visited emergency departments in Snohomish County, Washington 21 times or more in the 2002 fiscal year, 55% of them had both a mental illness, as well as substance abuse issues.

In strict regards to substance abusers, some of the problem of frequent users, and in turn overcrowding, can be attributed to patients that are seeking prescription substances that he or she may consume.  Most prevalent among these seekers are opiate-based pain management medications such as Oxycodone, Vicodin, Percocet, and the like.

Snohomish County, Washington emergency departments wrote, on average, 39 prescriptions for narcotics per patient that visited 21 times or more in the fiscal year 2002.  This translates into a supply of narcotics for one patient that lasts about 295 days.

There is problem among these chronic emergency department visitors.  To remedy this problem is to address the specific ailment the patient is complaining about, but to go beyond that one visit and to see the pattern.  These patients are going to the emergency department in an effort to attain drugs.  To combat this, one solution would be to address the  patient for substance abuse, which is out of the scope of many emergency department’s scope.

The Washington State Department of Social & Health Services conducted a study of patients that are receiving Social Security Supplemental Income (SSI) that enter chemical dependency treatment.  This study shows that of the patients that enter but do not complete a treatment program, frequent visits are reduced by 17%.  Patients that do complete a substance abuse treatment program are even further reduced by 48%.

The problem of frequent users of an emergency department could be rectified.  These patients seem to be slipping in between the cracks though.  The patients go to emergency departments because they know they will most likely be able to obtain narcotics, but the physicians are there to treat the patients chief complaint, not long term issues like that of substance abuse.  Furthermore the frequent user patient with substance abuse tendencies needs to want to enter treatment.  The patient cannot be forced to do so. 

A Fateful Leap

[Video content via The Columbus Dispatch]

During the early morning hours of Nov. 25, 2015 a young man was pulled from Mirror Lake in cardiac arrest during the annual jump at The Ohio State University. Soon afterward, university administration called for an end to the tradition. In recent years, the university has observed with greater vigilance the detrimental health effects of jumping into a pond in late November.

After the untimely death of one of the participants, Austin Singletary, a third-year student majoring in human nutrition, the student government coalesced with university administration to take proactive steps to put an end the tradition.

On Wednesday, The Ohio State student government voted on Resolution 48-R-21: A Resolution to Advocate for Student Safety by Ending the Mirror Lake Jump. The resolution passed 35-6 with 6 abstaining, according to a report in the student-run newspaper, The Lantern.

The university has attempted to quell the Mirror Lake jump since 2012 by imposing greater control over the event. That year was the first year the university required participants and spectators to wear wristbands. The university also erected a gate around the lake in an effort to prevent any premature jumping. The gate, however, was overrun by students taking place in a Monday jump, without wristbands, in 2013. Only those students with wristbands were permitted near the lake. Each subsequent year students were required to have wristbands.

The wristbands initiative have largely failed to stave off participants. According a previous report in The Columbus Dispatch, roughly 10,000 students continued to engage in the jump every year since 2012. In a separate report in The Lantern, 2014 saw 14,000 participants in the Mirror Lake jump.

At the Mirror Lake Jump a number first responders are on hand should a medical emergency transpire. In all, The Ohio State University Police, Columbus Police, Columbus Fire and Medics, as well as a dive team from Columbus Police are present to monitor the activity. Additionally, there is an increased presence of security personnel at the Abercrombie & Fitch Emergency Department at The Ohio State University Wexner Medical Center—Columbus and OSU police are present  to provide additional aid due to the influx of individuals presenting in need of medical attention.

Every student that participates in the jump that requires medical attention is sent the Abercrombie and Fitch Emergency Department at the Wexner Medical Center at The Ohio State University.

Emergency Department at University Hospital

Typically, participants that require medical attention are for relatively benign afflictions—issues raging anywhere from bumps and bruises to small lacerations. With the amount of participants presenting though, the emergency department becomes significantly inundated, which results in an overcrowding issue.

According to Michelle Ross, a nurse at the medical center, great efforts are made for this one night. Extra staff is taken on with nurses and healthcare providers in addition to the beefed of security presence.

Ohio State University Emergency Depart Trauma Bay

Ohio State University Emergency Department Trauma Bay

The emergency department prepares for the added number of patients from the event by keeping two of the trauma bays empty so that multiple patients can be seen in these rooms so as to expedite service for less severe patients–a phenomenon known as double stacking.

There are those patients that do present to the emergency department with significant medical issues—ranging anywhere from acute alcohol intoxication to serious hypothermia.

Patients who present with hypothermia are of the greatest risk. Participants immersed in water just above the freezing point for approximately two minutes will begin to experience reduced dexterity and confusion. Should a participant remain in the water for around 15 minutes, loss of consciousness is likely to occur, according to Ross. Furthermore, alcohol consumption can exacerbate these scenarios significantly. The dive team from Columbus Police perform crowd control in an attempt to limit participants in the water for no more than eight minutes at a time.

To treat the more extreme cases of hypothermia the university institutes rapid warming, which involves giving a patient warmed intravenous fluids. In the most extreme scenario, there are even machines that treat patients by filtering one’s blood and warming concurrently.