A&e regular attender

[ricepudding4]

I was channel surfing and there was of those 24 hours in A&E/999 type of shows- I watched it for 5 minutes but it featured people who go to a&e regularly and said they had been put on a frequent attender list/service thing, not quite blacklisted but certainly some kind of service where they were recognised as coming a lot and they were trying to manage how often they went to a&e. It got me thinking… is that something that happens to people who go for genuine reasons? The people included in the show were going with things that were not a&e appropriate, but if you do go to a&e regularly but it is appropriate will you still be registered as a frequent flier?

the only reason I’m asking is because I have a condition that requires me to go to a&e a lot. I’m genuinely unwell when it flares up and usually end up in Resus until it’s stabilised. I’ve been to a&e 6 ish times with it this year- I’m doing everything um
supposed to do to keep it as under control as possible but unfortunately sometimes it still flares up

i absolutely despise going to a&e because I don’t want to be a timewaster and it’s so embarrassing to be recognised because I’ve been regularly but I don’t have any other choice. After watching this, I’m sort of worried now that next time I’ll end up on some high intensity or frequent attender list or that someone is going to take me aside and speak to me about my frequent attendances like what happened in the tv programme. Does anyone know? Thanks 👍🏼

Ex a&e staff here. No you wouldn’t be recognised as such, staff may recognise you as being their frequently but having admissions to resus means you genuinely need to be there so please use the service when you need to!

our frequent attenders were generally there every other day. They were dependent on opioids and would self discharge once they had what they needed.

One of my children is marked as a 'frequent attendee' because he's been admitted several times with viral induced wheeze. He's 3 and has had at least 10 admissions, 3 of which have been in the last 3 months.

No one seems bothered, if anything it seems to get him seen and sorted out a bit faster as they are more aware of what treatment he responds to better. I like it because we have a pragmatic discussion about what to do and they know I know how to administer inhaler etc so it saves us all some time!

If you’re in resus absolutely no one is going to question your need to be there. I’m sorry things are so tough though

I only went once, paramedics who came out insisted, A&E immediately put me down as a time waster, put me in a side room, lied about my reports of my pain rating - said I said it was 0 out of 10 when it was never less than 8 and I was curled up in pain and projectile vomiting. They finally gave me a squirt of gaviscon and said it was indigestion despite me telling them it clearly wasnt - it was in the wrong place to start. They came up with some guff but no tests, no compassion and no care. I had gall stones - was sent home in agony. So no, unfortunately it does not take much for nurses to decide you are a time waster.

6 times a year is nothing. Some people attend A&E weekly or even more than that.

If you have a chronic condition that you are being treated for why don't you go direct to that department?

Problem is A&E is for accidents and emergencies, A&E is also where people tend to go for anything scary because they don't know where else to go or don't have anywhere else to go.

for example:

Pain/bleeding in early pregnancy. It obviously a horrible experience and people panic but A&E cannot and will not help unless you have had an immediately life a death level rupture and hemorrhage (rare).

EMU/EPU (early maternity/pregnancy unit) is where you need to go to be investigated and have any treatments done and they will book you straight in. Most people just don't know that though and spend hours sat scared, in pain and bleeding in A&E just to be discharged to their GP as its not an A&E matter without being pointed to the correct department.

Its often not people fault they are in the wrong place and many do genuinely need some medical attention. If only people where more clearly informed and sent to the correct area A&E wouldn't get so overwhelmed all the time.

We refer to them as high volume users. They get referred to the high volume user team.

Yes, if you are a high volume attendee for a medical condition you can be referred to this team.

I can’t remember the criteria but most patients I see who are registered as high volume users visit more than once a week.

It’s not a bad thing to be referred to this team. They help with identifying the reasons you attended A&E and help with support in the community to avoid crisis. This could be social support, help with identifying when the right time to go to A&E is or arranging appointments with a specialist to help sort out recurrent issues.

You can’t go directly to a ward unless you go via a&e, if you call the respiratory ward they will just say to go to A&E and if needed they will admit you. and sometimes I dont even need to be admitted , just need to be stabilised and then I’m good to go home

We had a very frequent flyer when I worked in acute nursing. Diabetic ketoacidosis every time, but she didn’t take any responsibility for her condition and openly said that she allowed herself to go into DKA because she enjoyed the attention she got when she was admitted. I’m amazed she is still alive because of the permanent and severe damage she’s done to her body (and I only know because she regularly posts in a local Facebook group that I’m also a member of!)

Your condition doesn’t sound like you have any warning or control over when it happens though, so please do get the emergency care you need when you need it!

From a GP perspective. We get a report about frequent a&e (and 111) users. We discuss them at our safeguarding meeting. If there is good reason for them to be using it we may be concerned that their medical needs are not being met in primary care and get them in to see us.

If they are persistent users for no reason we will try and speak to them but it doesn't usually come to much as they tend to not engage with us.

Most frequent users are known to the GP practice anyway.

More the ones who go for no reason i should think

Im a regular, like you, long term chronic sick, no other options but to go in for tests, monitoring and drips and things

Its a big major trauma centre with a helipad etc and im sometimes recognised by name in the corridor (its embarrassing) but its not because i go for no reason, its because im there so often due to illnesses

The last time i was there after a CT scan, the wait for a porter was ages, and i asked if i could make my own way back, one was hesitant, the other said, oh thats ok, she’s ‘name’ shes here often, she will be ok to go back on her own

I have a cousin who is a paramedic. Her take, I'm sure, would be it won't be "blacklisting" unless you are actually calling an ambulance or self reporting at A+E when your condition doesn't warrant immediate treatment, or you could get to A+E easily yourself.

What they should be doing, is trying to work out whether there is anything else that could be done to prevent flare ups being so regular or so severe that they need A+E often. I don't think it will be about "blacklisting", it will be about tracking and working out whether their A&E attendance could be reduced with better involvement of other services.

I don’t understand that. I had to attend A&E twice, years apart, for an excruciating reaction to an infusion I’d had. First time I was given Oramorph, which helped a bit. Second time I was told that they could not prescribe any painkillers- nothing at all. I was in so much pain I couldn’t sit or lie down and had to keep moving, even talking to the Dr in A&E I was walking up and down the room, I slept standing up, hanging over the footboard of my bed. This was - of course it was- on a Friday and I had 60 hours of misery and despair until I could get a GP appointment on the Monday

Direct to what department?
It really is not that simple

I have multiple consultants in multiple areas,
Do you think i could just turn up at that clinic and say ‘Hi’
Even if it was during clinic hours, it doesnt work like that at all , clinics often cant give you the treatment that you need (especially in an emergency)

When im in A&E sometimes one of my consultants is called but you cant just go to that department (even if it was open)

My daughter has Asthma and it’s one condition than have medical staff worried. I bet you are straight in when you have been triaged and you are in resus. i assure you you have to be pretty ill to be in resus so you obviously need to be there.

I don't think anyone was suggesting that, just that there may be suitable alternatives available. It will differ by area but some near me are crisis teams, evening mental health drop in cafes, and a mental health emergency centre as well as eg: GP, samaritans and shout, and talking therapies before crisis point. A and E will of course be appropriate for some mental health issues but in some cases it is definitely not the best environment for people in mental distress.

I find your comment very concerning. As anyone who has had or witnessed a full on anxiety attack knows, it can be incredibly frightening. Confusing the symptoms with more serious illness is very common. But what happens on the times it is a genuine major health event and the patient is left longer than they should be due to previous visits.

Yep this is what happens and when people are talking about stigma around mh they are mainly talking about the way they are treated by medical staff. Iv been almost killed multiple times by nhs staff due to comments in my medical records.

No idea why you have chosen to incorrectly read and react to my post this way. I have mental health issues.

I have multiple health conditions I know how things work.

Of course in an emergency you go to A&E, say you have a chronic heart condition but then suffer a sudden heart attack out of nowhere then you of course go to A&E.

If you have a chronic condition and are having a heart attack every month ending up in A&E then the question is why? and what is not being managed properly. That's something you go to the specific department for to prevent it before it gets to emergency.

Even if you have an emergency you are suppose to be discharged to the correct team to STOP it happening again.

A lot of A&E time is wasted by people with legitimate long term medical issues who do in fact need help but who do not manage their condition in day to day life until the emergency point or because of a failure in the collapsing NHS system where they are not being treated correctly (Ive been there too, COVID was a bloody awful time for getting help and I ended up in A&E due to it many time over the lockdown period).

If anyone finds themselves a frequent flier in A&E because of a on going condition they should be pulling up their specialist though. They deserve to have proper preventative treatment not walk a knife edge of just surviving.

If its a case that they actively refuse any help or do not keep up the treatment program then they are either a nuisance or more likely should likely be refereed for evaluation to assess their capability to care for themselves (physically or mentally).

@JessicaPeach , one of my DC was the same, she was finally diagnosed as having asthma and given low dose steroid inhalers... and 10 years later, has never needed an A&E admission for respiratory issues since.
I was told they "don't like" diagnosing asthma in under 6's, but ultimately did for DC due to number & frequency of admission to hospital with viral wheeze.
Might be worth asking for a referral to follow up.

If you have a serious condition of course you should be there. That being said, your doctor is failing you with long term treatment if you need to keep going with the same condition, they should have you referred to someone who can get it stable

I would imagine you might have an alert on your electronic records to rapidly show staff that you have a known condition that flares up - and if it is a high risk scenario like brittle asthma or severe epilepsy there may be a specific 'rescue' plan from your specialist - speeding up urgent care.
Depending on how the electronic records are arranged the alerts may look different for a 'frequent attender' for mental health or social reasons, or substance misuse. Likely to be a specific icon for someone with a history of violence to staff.
What icons they use and how niche they get will depend on the computer program the trust uses. I often struggle to work out what on earth all the icons mean to be honest (but I don't work in ED!)

You say you know how things work but you said ‘Why dont you go direct to that department’
So im telling you thats not how it works

A condition can be well managed and controlled ‘in clinic’ and health care providers doing everything they can but that does not mean you will never need A&E for that particular condition and to be honest its just daft to think that all conditions can be sorted in clinic

If your multiple health conditions can be treated in clinic and there is never a need for A&E then great for you

But i have multiple conditions where i am very well looked after in Clinic (They couldnt do more) but i sometimes need to go to A&E in between those times
Its got nothing to do with the consultant or the clinic not looking after me well enough
its a symptom of a condition that sometime needs emergency treatment
Which by the sounds of it is the same as the OP

This.

I used to be a frequent flyer to A&E for mental health. Believe me, I never took myself there... was always taken by police or paramedics that had convinced me to go. I was considered a high user of 999 services, and was under Serenity Integrated Mentoring (now stopped, as it was actually harmful to patients... it was basically criminalising being in crisis - have a Google for StopSIM if you want to read more about it).

One A&E nurse was very kind and said that most people who come to A&E get sorted there and then, or moved to a ward where they have some more treatment/surgery etc.... with MH, it can be upsetting and frustrating to see someone in mental distress as they simply can not fix it there and then. It is always a long journey with therapy and lots of working on one's self. (unless it is something that a proper medication regime can fix).

In the main, for me, A&E was terrible for MH. I was on an assessment unit, and all 4 beds were mental health related. I could clearly hear the nurses saying "ooh, a few sections are going to be handed out", and basically gossiping about how the patients were presenting.