Emergency Department Physicians Growing Weary of Frequent Users

Emergency department (ED) physicians are frustrated and burned out from treating patients who frequent the ED on a regular basis for their care, according to a new survey.

Researchers at the Henry Ford Hospital (Detroit, MI, USA) compiled an 18-question, anonymous survey that was randomly sent to 1,500 physicians across the United States between July and October 2010. The questions were multiple-choice, and data was analyzed using the common statistical Chi Square test. Of the 1,500 surveys sent, 418 physicians responded, comprised of seasoned professionals, up-and-coming residents, and alumni whose experience ranged from one year to 30 years. The physicians defined frequent users in the survey as patients who visit the ED at least 10 times a year.

The survey found that 59% of physicians acknowledged having less empathy for so-called frequent users than for other patients, and 77% held bias for frequent users. Additionally, 91% of physicians said frequent users pose challenges for the ED; 71% of physicians believed a program to manage frequent users was necessary; and 82% of physicians said they felt some level of burnout, and that experience did not shield them from burnout. According to the researchers, many social factors contribute to patients frequently using the ED, including lack of access to primary and specialty care, homelessness, lack of transportation for appointments, substance abuse, psychiatric disorders, and chronic medical conditions. The findings were presented at the annual meeting of the Society for Academic Emergency Medicine, held during June 2011 in Boston (MA, USA).

"Our findings should be a wake-up call for hospital administrators to look at ways to manage these types of patients," said lead author and study presenter clinical psychologist Jennifer Peltzer-Jones, PsyD, of the department of emergency medicine. "Only 31% of the physicians surveyed said they had a program to help manage patients who are frequent users. Hospital administrators have to realize that these patients are invoking burnout and staff want and need additional resources."

"Physicians are feeling frustrated because they want to assist their patients who have emergent care issues. But they find they are managing chronic medical and social problems with very little resources," added Dr. Peltzer-Jones. "The Emergency Department is supposed to be the last, not first, resource for patient care; that's not the case with the frequent user population. ED physicians are not equipped to be primary care providers and case managers."

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