What do you guys do with frequent fliers?

[DrParasite]

This guy calls 911 for the same reason every time, exactly around 2am. He says he is in "pain." His vitals are always normal and is completely ambulatory. Ends up getting discharged 45 mins after getting to the ED

After making sure he doesn't have anything else going on, walk him down to the ambulance, have him sit on the bench, take a nice easy ride to the ER, fill out your paperwork, and leave him in triage.

It's easier for me to transport the willing patient than convincing him to refuse, or having him complain that we refused to take him to the hospital. I get paid by the hour, not the by run, and I need to fill out a PCR regardless. While I agree that he is abusing the system, transporting him makes my management happy, doesn't potentially violate any DOH rules, and exposes me to much less potential civil liability.

So why should I make my job harder?

 

[LanceCorpsman]

After making sure he doesn't have anything else going on, walk him down to the ambulance, have him sit on the bench, take a nice easy ride to the ER, fill out your paperwork, and leave him in triage.

Thats exactly what we do, but here is the catch. I don't get paid a penny to wake up at 2am to go pick him up.

 

[NomadicMedic]

Thats exactly what we do, but here is the catch. I don't get paid a penny to wake up at 2am to go pick him up.

Are you a volunteer? If the answer is yes, don't go.

If you're paid, you get up and go. You get paid to run calls, not sleep. Sleeping is a bonus.

 

[redundantbassist]

Thats exactly what we do, but here is the catch. I don't get paid a penny to wake up at 2am to go pick him up.

Turn the little knob on your pager all the way to the left before you go to sleep. Problem solved.

 

[SpecialK]

We have few "repeat customers" due to having universal healthcare.

It depends; Control can screen them out somewhere else via the Clinical Hub (i.e. not mount a response) and some "known" callers have a pre-determined plan agreed between them, their GP, whomever else is appropriate, and Clinical Development.

For ambulance personnel they are treated like any other patient; diagnose what is wrong with the patient, determine what they need and how they can best get it. They might frequently call for an unrelated problem so today's presentation is perfectly warranting of a) immediate referral to another place and b) transport there by an ambulance, or it might be not.

ePRF is going to be great for this because it is linked to the GP. With the single, national, electronic health record I imagine this will also extend other specialists.

 

[LanceCorpsman]

Are you a volunteer? If the answer is yes, don't go.

If you're paid, you get up and go. You get paid to run calls, not sleep. Sleeping is a bonus.

If I don't go, the next available paid department gets the call. However, they flat out refuse to respond to that address. So it ends up being another ambulance service (volunteer as well) that is 30 mins away from the scene who gets the call. I feel bad for those volunteers.

 

[LanceCorpsman]

Turn the little knob on your pager all the way to the left before you go to sleep. Problem solved.

Thats when I miss structure fires, Ive made that mistake before lol

 

[NomadicMedic]

If I don't go, the next available paid department gets the call. However, they flat out refuse to respond to that address. So it ends up being another ambulance service (volunteer as well) that is 30 mins away from the scene who gets the call. I feel bad for those volunteers.

Guess you're SOL.

 

[LanceCorpsman]

Guess you're SOL.

Damnit...

 

[Akulahawk]

Social workers have been working with this gentleman for years now, but he is very uncooperative. I am pretty sure the daughter of the pt (who lives with the pt) is taking advantage and smuggling some of the scripts. The daughter is usually sleeping in the next room when we come to his house around 2am. I even saw her take off in her car right when our ambulance came because I confronted the daughter, telling her that it would be a better idea if she just drove the pt to the ED.

Then you best document the snot out of those calls and involve APS or Law Enforcement for abuse of the 911 system. It may also be worth it to contact the hospital about him to find out what options they have. At my work we have a few frequent fliers. With those we usually started with the medical social worker and sometimes progressed to APS and/or LE involvement. Once that ball starts rolling, the frequent visits usually quickly cease. Believe me, once we recognize that we have a frequent flier, we document the snot out of their visits (and sometimes do more in-depth work) to establish a very strong pattern.

 

[MonkeyArrow]

I don't understand why more hospitals don't just MSE their frequent fliers. By law, all a hospital has to do is treat any unstable or imminent dangers to life (that't the jist of it). Why don't more hospitals have a MD/mid-level come out to triage and kick them to the curb? Of course this isn't a solution pre-hospitally, but eventually, if all the area hospitals start making these frequent flier stays less than 5 minutes, they're going to run out of places to go.

 

[SpecialK]

I don't understand why more hospitals don't just MSE their frequent fliers. By law, all a hospital has to do is treat any unstable or imminent dangers to life (that't the jist of it). Why don't more hospitals have a MD/mid-level come out to triage and kick them to the curb?

Explain how you can actually seriously say something that nasty and horrible about how to treat a fellow human?

Of course this isn't a solution pre-hospitally

Why not? Just because you call an ambulance doesn't mean a) one needs to be sent to you, and if it is b) you need go the hospital.

Eventually, if all the area hospitals start making these frequent flier stays less than 5 minutes, they're going to run out of places to go.

Five minutes? Surely you can't be serious? How on earth can you expect to do a thorough enough history (+/- exam) to determine what healthcare needs the patient has, and how to meet them most effective and efficiently, in under five minutes?

 

[LanceCorpsman]

Then you best document the snot out of those calls and involve APS or Law Enforcement for abuse of the 911 system. It may also be worth it to contact the hospital about him to find out what options they have. At my work we have a few frequent fliers. With those we usually started with the medical social worker and sometimes progressed to APS and/or LE involvement. Once that ball starts rolling, the frequent visits usually quickly cease. Believe me, once we recognize that we have a frequent flier, we document the snot out of their visits (and sometimes do more in-depth work) to establish a very strong pattern.

The hospital is very aware of this situation. We get that stare from the RNs whenever I come through the door with him. He goes to the ED every, single, day. He only calls the ambulance at 2am, like exactly. During the day he has his daughter drive him to the ED. The hospital has taken numerous measures to deal with this guy, but still no improvement.

 

[Bullets]

The hospital is very aware of this situation. We get that stare from the RNs whenever I come through the door with him. He goes to the ED every, single, day. He only calls the ambulance at 2am, like exactly. During the day he has his daughter drive him to the ED. The hospital has taken numerous measures to deal with this guy, but still no improvement.

So why not just go get him? If you know hes gonna call, then just go there and preempt his call.

We did that to a customer for a while

 

[thelapow]

We have a special ambulance for this - a "sociolance" (social worker+ambulance). Which deals with alot of cases on scene or find alternative ways to fix the problems with social services, rehab clinics and so on, they greatly reduce transports and load on the ER. All major cities should have this concept. Its like a normal als unit, with a mobile social services office.mnot sure it would work in your situation, but with homeless, drugusers and alchoholics and so on, its fantastic.

 

[MonkeyArrow]

Explain how you can actually seriously say something that nasty and horrible about how to treat a fellow human?

Once you have seen the same guy 5 days out of 7 every week for the past two years complaining of generalized body aches when he already has a group home and a physician he sees every day to get his medications administered to him, I really have no sympathy. I know as a fact that he has medical care easily accessible to him. Don't come in with the same BS when we have patients with legitimate complaints waiting.

Why not? Just because you call an ambulance doesn't mean a) one needs to be sent to you, and if it is b) you need go the hospital.

OP is presumably from the United States, where very very very few services have the ability to refuse transport or not send an ambulance. Thus, this is not a solution pre-hospitally for 99.9% of EMS workers, as I stated.

Five minutes? Surely you can't be serious? How on earth can you expect to do a thorough enough history (+/- exam) to determine what healthcare needs the patient has, and how to meet them most effective and efficiently, in under five minutes?

I am serious. There is no conceivable need to retake a full history on a guy who has 1000+ encounters in our EMR. The only pertinent history is: has anything changes since yesterday? The patient in question mostly always presents with body aches, a condition that he has been roomed and worked up for previously. There is nothing to indicate that his condition has changed significantly since the last time we worked him up. There is nothing immediately life threatening or endangering his health, which is what EMTALA requires hospitals to screen for. On the rare occasion that he does present with a different complaint, he gets MSEd and treated appropriately.

This scenario is completely relevant and parallel to OP's, in which a guy calls 911 frequently and returns to the same hospital with the same complaint. Nothing acute going on. We have no obligation to treat you. Good bye.