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

[Chance]

From WFAA.com:

Michael Johnson is 57. He’s from Dallas. He’s diabetic. He has a job in fast food. He rents a home. He gets by.

Until recently, no one ever explained to him how hospitals, doctors and emergency rooms work.

“My momma always told me when something’s wrong with you, go see the doctor,” Johnson said.

The only way he knew to see a doctor was go to the emergency room at Parkland Hospital, which is why he racked up 31 ER visits in 24 months.

Johnson’s numbers are not at all surprising for administrators at Parkland, which has one of the busiest emergency rooms in the country.

“It’s not unusual for us to see in excess of 700 people in a 24-hour period in our emergency room,” said Dr. Esmail Porsa, executive vice president and chief strategy and integration officer for Parkland Health and Hospital System.

Parkland’s ER is busy for countless reasons, but chief among them is repeat patients like Johnson. He’s considered a high emergency department utilizer because of those repeated visits.

High ER utilizers often take up valuable space which can lead to long waits, Porsa said. Because Parkland is a public hospital, these frequent patients cost Dallas County taxpayers money.

The hospital wanted to determine why these high utilizers keep coming in. But to do that, they needed to identify who they are.

“We looked at the data every which way. We looked at zip codes, gender, race, education, income. One day we sorted the data by medical record and realized — lo and behold — there were three patients on the top of the list,” Porsa said.

Those three patients visited the hospital 500 times in one year.

"Five hundred times," Porsa repeated.

Read the whole thing....

[blues]

"Haven't I seen you before?"

"How about you...do you come here often?"

"I only signed up recently. Friday nights are the best."

[Balisong]

As someone who started his nursing career in the ER, I 100% believe the facts of the story without needing to see further evidence.

Lonely people, drug seekers, homeless folks who say they have "chest pain" so they get a night out of the cold and some food.... lots of repeats there.

[Darth_Uno]

That's just sad on a number of levels. Go join a chess club or something.

I get it though. You go where people are nice to you. I see it at church (which is the whole purpose of church, to reach out, so I'm on board with it), we have a handful of people who don't contribute anything meaningful in the way of various ministries (and certainly not finances) but they're truly welcomed, and keep coming back. And this might be the only place where anyone actually takes an interest in them. Again, I'm fine with that at church. If I owned a hospital, maybe not so much.

[RevolverRob]

Humans are fundamentally social creatures. That is why solitary confinement is such a harsh punishment.

Amongst the most marginalized are the elderly and disabled.

Churches and Meals on Wheels have probably saved more lives from suicide than the suicide prevention hotline ever will. Sometimes, all you need is someone to talk to, about nothing in particular.

It can be very difficult for busy folks to remember this, but talking to your elderly neighbor for five minutes or acknowledging their existence, is all it takes. Ed Calderon makes a point of this in his urban movement discussion, the elderly and homeless are amazing resources of information and can provide help with a few kind words or a small “token” gesture that shows you are an actual human being.

With suicide rates now trending to be the highest among the elderly, it’s important to remember and think about these things.

[blues]

I thought this was why there were so many colleges and universities...



(kidding...somewhat. )

[45dotACP]

Sensei would be the guy to hear from about this stuff, but I'm absolutely unsurprised.

Sometimes these high level trauma centers like Parkland, have surrounding areas that are...shall we say...benighted. Patients unable to refill or afford their meds, people who can't read at a high enough level to comprehend discharge instructions, people who don't have insurance, let alone primary care physicians.

Seeing 700 patients a day is an extremely high volume ER. My hospital sees maybe 400 a day and is considered one of the busiest level 1s in the Chicago Southside and we do a lot of similar things mentioned in the article because the readmission rates are just silly for some patients.

Sent from my moto g(6) using Tapatalk

[RevolverRob]

It’s worth bearing in mind that Parkland is the primary indigent serving hospital that serves basically Dallas and a number of surrounding suburbs, a population number measured in 7-digits.

My mother-in-law recently retired from 20 years working at Parkland as a NP, spending time in ER, OB-GYN clinic, and Delivery. Her stories are basically nightmarish. When Parkland moved to its new location, they managed to fuck patient management up in the extreme. The staff turnover in any ER is already high, but has reached a new level since “new” Parkland opened a few years ago. Half of the systems still don’t work right, but the old adage of cutting staff and replacing with automation is prevalent there. But more worrying, Parkland increased it’s bed capacity, in theory, but functionally did not. Bed turn overs are too high to maintain quality and proper cleanliness standards.

But perhaps the biggest problem is as I noted above - Parkland is basically “it” for indigent healthcare in Dallas, a vestige of another era (i.e., segregation). And rather than add another hospital (or better, a number of clinics) to treat the problem, they tried to bandage it up and hope that something would just work out.

But maybe it will work out. Given the rapidly rising cost of living in Dallas and surrounding ‘burbia it could well be that the indigent are merely pushed to a surrounding county making it “their” problem.

[andre3k]

"Haven't I seen you before?"

"How about you...do you come here often?"

"I only signed up recently. Friday nights are the best."

You're missing the homeless schizophrenic guy, the crackhead and the meth monster. The people in that pic look like they all have jobs.

[Sensei]

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.