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Thread: 80 people went to Dallas ERs 5,139 times in a year — usually because they were lonely

  1. #11
    Site Supporter DocGKR's Avatar
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    Yup--lots of fine folks using the ED for everything EXCEPT for what it was intended to do...
    Facts matter...Feelings Can Lie

  2. #12
    banana republican blues's Avatar
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    Quote Originally Posted by andre3k View Post
    You're missing the homeless schizophrenic guy, the crackhead and the meth monster. The people in that pic look like they all have jobs.
    I was trying to make it look like date night at the ER...as opposed to what I used to encounter at Bellevue (NYC) on a Friday night which was gruesome on a whole bunch of levels from gore to gross.
    There's nothing civil about this war.

    Read: Harrison Bergeron

  3. #13
    Member Balisong's Avatar
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    Arizona
    Quote Originally Posted by DocGKR View Post
    Yup--lots of fine folks using the ED for everything EXCEPT for what it was intended to do...
    Are you insinuating that 13 year old girls shouldn't be coming into the ER just to get a pregnancy test? What you suggest is madness, sir. Pure madness.

  4. #14
    Site Supporter DocGKR's Avatar
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    Feb 2011
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    or for runny noses, mild rashes, non-urgent dental issues like a broken denture, post-operative visits, routine check-ups, etc.....
    Facts matter...Feelings Can Lie

  5. #15
    Quote Originally Posted by Sensei View Post
    There has been a fair amount of research on ED “super users” over the last 5 years. IMHO, most of the studies are methodologically flawed since they look at only Medicare/Medicaid super users (omitting the uninsured), but these studies show that many of these people have active medical conditions such as congestive heart failure, end-stage renal disease, major psych illness, etc. They spend blocks of time as ED super users when there illness becomes unstable and require admission at a much higher rate than the general ED population. Then, they suddenly disappear once their illness becomes dormant (or, they die or get incarcerated). Identifying effective strategies to deal with these patients can be tough due to the heterogeneity of what drives their visit. That is to say, interventions that work on a renal patient who frequently skips dialysis because they lost their transportation are vastly different than what helps the homeless guy with schizophrenia who is constantly being dropped off in the ED by the cops for chasing cars and pissing on fire hydrants. Intensive case management with a social workers seem to help some.
    I read a similar article about a different city, where the top user had logged 400+ ED visits in a year. He was a homeless man with some chronic health issues. From a dollar standpoint, it was a lot cheaper to set him up in an apartment with a caseworker than to have him on the street being picked up every night.

  6. #16
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    May 2015
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    I had a loser with a tooth ache that wanted an ambulance ride to the ER at 0300hrs. I just drove him there in the patrol car and dropped him off. It always seemed to go beyond being poor. There are a lot of poor hard working people that do the right thing. Then you have the parasites. They not only don’t have a job but they don’t have an alarm clock. Not to mention a garbage can, wash basket, or a bed. The mattress is on the floor, the garbage pile in a corner and the dirty wash is piled in another corner. But they have drugs, beer, 100 pair of sneakers, and a huge TV

  7. #17
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by Sensei View Post
    There has been a fair amount of research on ED “super users” over the last 5 years. IMHO, most of the studies are methodologically flawed since they look at only Medicare/Medicaid super users (omitting the uninsured), but these studies show that many of these people have active medical conditions such as congestive heart failure, end-stage renal disease, major psych illness, etc. They spend blocks of time as ED super users when there illness becomes unstable and require admission at a much higher rate than the general ED population. Then, they suddenly disappear once their illness becomes dormant (or, they die or get incarcerated). Identifying effective strategies to deal with these patients can be tough due to the heterogeneity of what drives their visit. That is to say, interventions that work on a renal patient who frequently skips dialysis because they lost their transportation are vastly different than what helps the homeless guy with schizophrenia who is constantly being dropped off in the ED by the cops for chasing cars and pissing on fire hydrants. Intensive case management with a social workers seem to help some.

    I don’t have the answer because none exists. What you are seeing is the slow implosion of our healthcare system that is now unavoidable. The ED is the epicenter of the collapse and the epitome of all that is wrong with our system. I’ve changed my practice environment to only working in the ICUs because the ED has become the scrotum of the healthcare system.

    Did I mention I'm thinking about anesthesia ?

    As you mention, it is important to not forget that a lot of people who are ED frequent fliers are capital-S Sick. A lot of it can be sourced to a complex and unnavigable psychosocial morass (eg undocumented immigrants taking K+ supplements so they will be eligible for dialysis through the ED) . Hard to be mad at folks like that.

    Sure there are the worried well but that's what triage nurses are for. The ED i am most familiar with does not get very many of the worried well. Anecdotally what ends up being a bigger issue are 911 calls on the homeless observed to be "found down" (aka sleeping where they usually sleep) and EMS brings them in after bystander 911 call, turns out they're intoxicated, need to sober clinically before they can be d/c'd....

    The ED is also the front line for the overwhelming number of untreated psych patients in socioeconomic distress (homeless, institutionalized, disabled, all 3...), who place an identical burden on 1st responders; itself a massive issue.
    Last edited by Nephrology; 05-30-2019 at 10:02 PM.

  8. #18
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    And some don’t know any better. My students thought nothing was wrong with going to the ER for minor complaints because such was the practice in their families and had been for generations. Also they did not understand the concept of triage and would express outrage when others were treated ahead of them.

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