FRIDAY, June 10 (HealthDay News) -- Americans who routinely turn
to hospital emergency departments for non-urgent primary care are a
big source of frustration and stress for the doctors who run those
facilities, a new national survey reveals.
Roughly 90 percent of ER doctors polled said that the frequent
draining of emergency resources and staff to manage chronic medical
and social issues is a problem and a challenge.
"What we found is that emergency department doctors recognize that this is a problem and are asking for help," said study author Jennifer Peltzer-Jones, a clinical psychologist and registered nurse in the department of emergency medicine at Henry Ford Hospital, in Detroit. In some cases, patients are coming back 20, 30 or 40 times a year, she added.
"Most, 97 percent, of physicians stated that they have frequent users," she said. "So, this is a national problem."
While more than two-thirds said that hospital administrators
need to implement programs to manage the problem, fewer than
one-third said their hospitals had actually done so.
The result: a drop in empathy for frequent-use patients, coupled
with a rise in physician burnout.
The researchers, who defined frequent ER users as those seeking
emergency room care 10 or more times a year, presented their
findings recently at a meeting of the Society for Academic
Emergency Medicine.
A lack of medical insurance is not always the prime motivation
for seeking care in an ER setting, the researchers found. Frequent
users, they said, often struggle with a chronic medical condition
while lacking easy access to a primary care doctor or specialist.
In some cases, homelessness and lack of transportation resources
play a role. Substance abuse and psychiatric illness were also
cited.
Between July and October 2010, the researchers polled 1,000
members of the American College of Emergency Physicians, and 500
hospital physician residents, staff members and former employees.
More than a quarter (representing ER staff in all states except for
Alaska) responded.
Eighty-two percent said they felt some degree of burnout as a
result of trying to cope with the inappropriate frequent use of
their ER.
Aspects of burnout included feeling emotionally exhausted,
treating patients with an increasingly depersonalized eye, and/or a
plummeting sense of personal accomplishment on the job.
Being an "experienced" ER physician did
not appear to protect physicians from the threat of burnout,
the survey indicated.
Nearly six in 10 ER doctors said they felt less empathy for
frequent ER users than for those seeking appropriate urgent care.
About three-quarters said they bore a bias against such frequent
users.
The survey did not address how lack of empathy might affect
quality of care, Peltzer-Jones noted.
"If we don't want our health-care providers to burn out, I think hospitals really have a responsibility to help them and provide some kind of program for these patients," she added. "Because at a minimum, it is having an effect on staff."
Dr. Marshall Morgan, chief of emergency medicine at Ronald
Reagan UCLA Medical Center in Los Angeles, said he was not
surprised by the poll results.
"Frequent use patients tend to have problems that can't be managed well in an emergency department," he said. "Some lack insurance, and so they have problems that need to be addressed but can't set themselves up with a continuity doctor because they can't afford it. Others have chronic pain problems and come in looking for relief, and often have developed a dependence on pain medication, particularly narcotics. And this makes ER doctors particularly crazy and frustrated. Which is understandable."
"Managing these patients better can not only make your staff happier, but it can also pay off in the long run," Morgan said. "Because they take up a lot of staff time, and are a huge cost to a hospital that will often not get reimbursed. But I don't know of very many places that have done an effective job at coping with the problem."
Because the research was presented in a meeting, the findings
should be considered preliminary until published in a peer-reviewed
journal.
More information
For more on ERs and non-urgent care, visit the
Careforall.net.