People who regularly visit the emergency department are often called frequent fliers. While this term isn’t always intended to be dismissive or negative, calling someone a “Frequent Flier” often mistakenly blames the individual instead of considering the broader social factors involved.
While a small portion of the population may genuinely misuse the 911 system or ER, allowing those few to influence our view of the many only creates more issues. When it comes to people who frequently visit the ER, we need to focus on underlying problems to find real solutions.
Why the Term “Frequent Flier” is The Wrong Way to Characterize People Using the ER (And How MIH-CP Teams Can Help)
To begin this discussion of frequent ED utilizers in MIH-CP, we’ll start with a quick example. Consider Jane. Jane is a new nurse just out of school. She took a job in the ER, and on her first day, Kate, a veteran nurse, is showing her around.
During their first day tour of the ER, EMS arrives with a man on a stretcher. “Oh, look,” Kate says. “Bob’s back.” Jane looks at the man on the stretcher. “Who’s Bob?” Kate waves to Bob as he rolls by on the stretcher, with paramedics taking him to his usual bed in the hallway. “Bob’s just a frequent flyer. You’ll see him here all the time. But he’s nice, so it’s fine.” Jane nods, and they continue the tour.
This brief illustration aims to share two important points. First, healthcare providers aren’t always frustrated by what some call frequent fliers. In fact, paramedics and nurses often become accustomed to seeing them, and–like catching up with a friend, they might even look forward to their regular visits and the chance to reconnect.
Second, the term ‘frequent flyer’ is not always meant to be derogatory. In many places, this is simply what people call someone who is seen regularly in the emergency department or who frequently calls the ambulance for help.
Third, although the term ‘frequent flyer’ isn’t always meant to be sarcastic or demeaning, it is almost always, whether the healthcare provider realizes it or not, dismissive. And that dismissiveness is the real issue.
In essence, it’s the acceptance of the fact that someone is a “frequent flyer” that can be dangerous, because this acceptance means health professionals believe that a “frequent flyer” is a type of person (incorrect), rather than someone who happens to be swept up by the social determinants around them.
Here’s what you need to know about ambulance and frequent ED utilizers (aka, frequent fliers):
- Calling people “Frequent Flyers” shifts the focus from what is truly important
- Understanding social determinants of health (SDOH)
- Frequent ED utilizers in MIH-CP often don’t know where to turn (healthcare education)
- Mismanaged chronic diseases are more likely to cause some to return to the ER regularly
- MIH teams can intervene to close the gaps in healthcare social determinants
Now let’s look at these points in more detail.
SDOH and MIH: Calling People ‘Frequent Fliers’ Misses the Point
When we discuss social determinants of health in the same sentence as “frequent flyers,” our aim is to shift the conversation. Instead of believing the issue naturally resides in any specific type of person, we want to view it from a broader, more systemic perspective.
When we blame a person who often visits the ER, we’re focusing on the outcome rather than the underlying cause. Instead, we should strive to understand why someone ends up at the ER multiple times within a few months, avoiding oversimplified and unhelpful explanations like, “Well, because they’re a frequent flyer, of course!”.
Many people who frequently visit the ER live in desperate circumstances. They may have very limited social support and unstable housing, or they might suffer from a chronic illness they can’t manage and desperately seek relief. Their desperation can stem from social, physical, or mental pressures.
Regardless of the reason, health providers should try to look past the dismissive label “Frequent Flyer” and start examining the true reasons people spend so much time in the ER.
Once we begin to identify sources, we can start finding solutions.
Why Healthcare Should Focus More on SDOH for Frequent ED Utilizers in MIH-CP
Instead of dismissing people as frequent fliers, healthcare providers should examine the situation more carefully. Often, they will discover that social determinants of health are responsible for the frequent use of the emergency room.
What do we mean by social determinants of health (SDOH), these are social factors that can influence a person’s health. For example, if someone lives near an area with high pollution, they may be more likely to develop chronic lung problems. Similarly, if someone has worked in dangerous conditions their whole life (without proper respiratory protection), they could have a higher chance of developing chronic lung disease.
The list continues. Many individuals have very little social support from family or friends, so they turn to the professionals at the ED to fill the void. Others may happen to live in areas with limited access to primary care physicians. These individuals are more likely to have uncontrolled chronic illnesses and, as a result, are more likely to visit the ER.
As you can see, when providers look more closely, there are real reasons why people call 911 so often. It’s not just because “they’re a frequent flyer,” but because they face very real (often unseen) pressures in their lives. Pressures that are usually beyond their control.
Fortunately, MIH-CP can ease some of this pressure.
How MIH-CP Can Help Manage High Emergency Room Use: Beginning with Education and Outreach
MIH-CP programs can assist individuals who frequently visit the emergency department. They mainly do this by reaching out to those identified as frequent fliers. They will approach these individuals and start by trying to understand their circumstances. They will ask questions about their social support, evaluate their living environment, and establish a baseline for any chronic illnesses. Once an MIH-CP completes this step, they are much closer to providing the patient with the help they need.
Understanding the Relationship Between Social Determinants, Chronic Disease, and ER Use
After a community paramedicine team visits a patient for the first time, they will attempt to develop a treatment plan. As they create this plan, they consider how social determinants, chronic diseases, and ER use all interact.
For example, think of someone with a cardiac condition. They might experience chest pain and have visited the ER seven times in the past year for uncontrolled angina. In these cases, the MIH-CP will try to identify the cause of the problem.
Is it simply that the patient has a severe case of coronary artery disease? Or is it because they lack a primary care physician they can reliably contact for concerns?
Maybe it’s something simple, like the patient not having reliable transportation to get to the pharmacy to fill their prescriptions. Because of this, it could be that the patient is skipping days, rationing their medications, and making their symptoms worse.
In this case, the MIH-CP could enroll the patient in a medication delivery program. Perhaps this is the solution—now the patient experiences less chest pain because they are consistently taking their meds, which leads to fewer visits to the ER.
Reduce ED High Utilizers by Using Advanced Metrics to Target and Close Social Gaps in Healthcare
Everything that we’ve discussed in this article requires data. This means collecting, evaluating, and distributing data to the providers who need it. Providing a platform for data collection is one of the ways that MIH-CP builds a strong bridge that can help aid patients who frequently use the ER.
A tool like Julota offers everything the MIH providers require to organize a care plan safely and effectively for someone who may be suffering from chronic diseases due to SDOH.
The Big Picture: Mobile Integrated Healthcare Can Manage SDOH to Reduce High ER Use
For many, it’s easy to take the path of least resistance and just call someone regularly in the ER a “frequent flier” and then move on. But that won’t fix the problem. For real results, we need to look at real causes. Understanding how social determinants of health affect people who regularly use the ER is incredibly useful for building empathy and finding real solutions.
Contact the team at Julota to see how their services can significantly improve your ability to gather key data on familiar faces and help reduce ER overcrowding.
