how does your department handle super-utilizers?

[doctorFred]

we have a pilot program here of a dozen or so individuals who have been designated as "exceptional" patients for various reasons (i think most of you get the gist.)

the exceptional patient list is made to streamline their department visits. it has a brief med summary for each individual, as well as a pain control algorithm that essentially restricts their access to narcotics. (it isn't entirely about narcs, though; there's one patient whose instructions describe the operation and maintenance of an unusual piece of medical equipment.) it's still a work in progress but preliminary data suggests they have utilized the ED less frequently once implemented.

any similar programs in place where you work? any thoughts? i've always been interested in department flow and logistics, including the handling of so-called super-utilizers.

p.s. -- no clue how i closed the other thread. i was just trying to fix the typo in the title.

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[Doctor Bob]

how does your department handle super-utilizers?

High velocity intracranial ballistic lead therapy

 

[docB]

We don't have anything written down. We jsut get to know them and streamline their visits accordingly.

One thing i have started doing is dictating notes on these patients. We use Tsheets and almost no one goes into the program that lets you review hand written stuff from past visits. Everyone looks at old transcribed notes such as discharge summaries, etc. I've started dictating notes about "pt well known to me as a drug seeker..." and so on. That way others down the line may start out a step ahead.

 

[WilcoWorld]

My department generally handles these patients with crossed fingers and whispered incantations in hopes that the patient gets sent to the other pod followed by a lot of grumbling if the chart ends up in our rack.

Surprisingly, this hasn't helped much.

Annals of EM published a review article in July on these folks (Frequent Users of Emergency Departments, LaCalee et al) which basically concluded that many of our assumptions are wrong and that more research is needed on the topic. Not all that helpful.

With really aggregious offenders I'll often do ask DocB does and type a special note in the computer in hopes that someone will read it before ordering hydromorphone IVP and a CT abdomen on the next visit.

 

[EM2BE]

We have a file cabinet with files containing exactly what you described and the pt's name will get flagged in the system as soon as they check in.

 

[RxnMan]

I just got this in my ACEP weekend review:

Doctors who work in Swedish Hospitals' Cherry Hill and First Hill emergency departments will no longer write prescriptions for Schedule II narcotics