Hospital “Frequent Flyers” Identified

Patients with psychiatric disorders and those with chronic pain used a disproportionally high amount of healthcare resources due to frequent hospital readmission, a new study claims.

Researchers at the University of California San Francisco (UCSF; USA) examined the administrative data at the 600-bed academic medical center and found that a high-use cohort that represented only 1% of all admissions accounted for 13% of readmissions. The group had a total of 372 visits and a 61% admission rate, with 87% being admitted to the medical service. In all, they took up 1,269 bed days. More than 90% of the cohort had a primary care physician associated with the hospital and 100% were insured, privately or publicly; a total of 93% had some sort of housing, though in 17% this was considered marginal.

The researchers then undertook a chart review of 29 patients who had an index admission during 2011 and 6 or more readmissions. Of these, 55% had psychiatric conditions and 52% had chronic pain. They then looked at the details for each of 145 of the individual visits and found that in 28% the criteria for terminal care were met, yet only 50% of these patients received a palliative care consultation and only a single patient was discharged to hospice. Among the 55% of patients with psychiatric diagnoses, mostly depression, only 10% were actively seeing a psychiatrist; few of the chronic pain patients were seeing a specialist for their condition, as well. The study was presented at the Society of Hospital Medicine annual meeting, held during April 2012 in San Diego (CA, USA).

“What we learned from this analysis was that these patients that have advanced disease, such as end-stage renal disease, have difficult to control symptoms, such as persistent vomiting, report chronic pain, so we wondered about the abuse of narcotics, and a host of psychiatric and social problems,” said study presenter Michael Hwa, MD. “They do appear to be well-connected with the healthcare system, so the questions were raised as to whether these patients represent ineffective use of the hospital resources, or even the right resources, particularly since few were seeing the appropriate specialists.”

Dr. Hwa added that the study implied that a more individualized multidisciplinary approach may be necessary, more closely involving nurses, social workers, and emergency department (ED) staff, and that their next step will be to try to identify patients before they become high users and to develop an intervention that will limit the need for readmissions.

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