Cape Fear Valley Emergency Department study finds few frequent users; most need to be there

May 25--Cape Fear Valley Medical Center's Emergency Department is among the busiest in the nation. About 96,000 adults stream through each year, and sometimes patient volume can overwhelm its capacity and result in long wait times for patients, as happened last week during a sudden, unexplained patient surge.

In that instance, patients were so backed up that the health system recommended seeking treatment at another hospital. One woman, Christina St. Romain, said she and her son were at the hospital for 17 hours before he was discharged with a concussion diagnosis.

Often, long waits are attributed to patients whose condition does not require emergency care but who seek treatment in the Emergency Department, where they cannot be turned away because of insurance status or inability to pay.

But a recent analysis of the hospital's emergency patients surprised some hospital leaders, showing that only 6 percent of patients were what are called "frequent flyers," defined as visiting more than 12 times annually.

"When you recognize people coming in and you've taken care of them before ... I think sometimes certain things stick in our heads," said Dr. Michael Zappa, an emergency physician and associate chief medical officer for Cape Fear Valley.

Of the fewer than 6,000 patients characterized as frequent flyers, Zappa said, 75 percent "absolutely needed to be handled in an emergency setting."

"That means that the remaining 25 percent -- or 1.5 percent of our overall volume -- would be frequent flyers that probably could have gotten care in another setting," he said.

There's no real national definition for frequent flyers, but it seems the definition used for Cape Fear Valley's analysis is at the top of the range. A 2010 review of such patients in the Annals of Emergency Medicine noted the definition of frequent users ranged from two to 12 visits per year. When defined as four or more visits per year, the study found, frequent users accounted for between 4.5 and 8 percent of all emergency department patients and between 21 and 28 percent of all visits.

The review showed that the uninsured, representing about 15 percent of frequent flyers, are no more likely to be frequent than occasional users of emergency departments. But those covered by government programs Medicaid and Medicare are much more likely to show up repeatedly.

At Cape Fear Valley, among patients overall, about 75 percent of the people who visit the Emergency Department need to be there, Zappa said. "There's nowhere (else) they can be taken care of," he said.

But of the remaining 25 percent of patients -- both the frequent flyers and other Emergency Department users -- it's unclear how many had conditions that needed to be treated within 24 hours.

Nationwide, only about 8 percent of all emergency department visits are classified as nonurgent, according to the 2011 National Hospital Ambulatory Medical Care Survey, meaning they don't need care within two hours, but they should be seen within 24 hours.

Zappa said the hospital also did not drill down to how many frequent flyers were uninsured or how many sought treatment after hours, when clinics and urgent care offices would be closed.

Of the 25 percent of those patients who did not need emergency care, he said, "by their diagnosis and medical condition, they could have been treated somewhere else," he said, "but we didn't go so far as to say in reality, could they have?"

Nationally, 60 percent of all emergency department patients arrived outside of normal weekday business hours, according to the same 2011 survey.

Regardless of why patients seek treatment in the emergency room, the staff is there to care for them, Zappa said.

"Absolutely is it the right thing to do, not only from a moral and ethical standpoint," he said, but also from the standpoint of having the health infrastructure to accommodate after-hours care.

"We are here for 24 hours a day, seven days a week to take care of your emergencies, from the minor to the major," he said. "That's what we do, and we're happy to do it."

Staff writer Paige Rentz can be reached at [email protected] or 486-2728.

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