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 👍🏼

Omg im so glad they stopped sim I didn't even realise iv been out the mh/hospital loop for a long time now that's great news it was absolutely disgusting that, that was even allowed to happen

The problems with overuse of A&E fall into different categories and the reasons are complex. The last time I was at minor injuries with my DH there were:

• A young woman being detained by police officers for “kicking off” outside. She appeared to have been brought in with some care workers of some description.
• A woman who confessed she was only there because she had not been able to get a GP appointment and ultimately gave up waiting and went home.
• A man who told me he was there for an infected cyst (an issue for the GP/pharmacy)

Among these characters you likely have:

• people who are bored and enjoy the drama of attending and telling people about it/checking in on fb
• people who have health anxiety and think a problem is much more serious than it is
• people who are experiencing acute MH crisis and need urgent intervention
• those people who are at a genuine loss of what medical treatment is most appropriate for them and to be fair it can be confusing as what is available is not consistent across areas.

Any of the first three are a cause for concern imo and need support to unpick the reasons for their frequent inappropriate attendance. Someone who attends regularly with an actual medial problem is not a cause for concern in this way but I would expect they would be concerned the condition is not being adequately managed at home.

I was what you would call a frequent flyer years back im doing a lot better these days but that is completely down to my gp who has been so supportive and has given me so much of his time and help to get out of the situation I was in. I'm one of the lucky ones and that's 100% down to him if he hadn't helped me the way he did I would of carried on as I was and probably be dead now

My elderly mother goes through phases of being a frequent flyer. We managed three visits in A fortnight recently, but there's never been any suggestion that it was inappropriate. It's got to the stage where we not only recognise some of the staff, but also some of the other regulars. The most that has happened in her case is referring her on to the age team so that they can check she has everything she needs at home.

I got told off for going to the urgent care walk-in just one time ever! It was the first time I'd ever been. History - I'd had a cough/cold about a year before and went to GP. GP diagnosed pneumonia and told me off for just leaving it so long and not coming sooner. Said that if I get a cough like this again, I need to see someone. A year later I had a cough/ cold that felt exactly the same so went to the walk-in. It wasn't pneumonia this time and I got told off for attending with just a cough.

The patient is not left to wait longer. As many previous posters mentioned, marking someone as frequent attendant usually triggers a review to identify why they are attending and how they can be better supported through other avenues, including primary care. It's not a punitive practice. I just don't necessarily agree with it being kept on notes indefinitely. I think notes should be updated based on more recent time-frames as it helps no one to still see a warning when their last attendance was 15 years ago.

@Carrotmccarrotface
Most people in a mental health crisis find A&E to be a very distressing place with all the lights, noise and people. Alternative pathways such as crisis response, safe havens etc....are often much more appropriate.

Unfortunately not everywhere has these in my area we have nothing

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

Of course you can. Ways to go directly to a ward (had these with DD)

Your GP rings a department and says they are sending you
Your hospital know you have something that can kick off, and you are given a form which allows you to present at a particular department (often for a time period eg a week)

You are under a particular consultant who runs a clinic which you are told you can attend if its at a time thats open
You have a specialist nursing team and are given specific contact details for them (DD has had this for cardiac).

Its quite unusual to have a well managed chronic condition that means you end up at a&e a lot. Usually its indicative that something isn't being managed appropriately.

Me too. It was an awful scheme. I met the guy who ran it.. Paul Jennings. Totally out of touch with the people who were in distress. Made it all about him (he had been 136d in the past.. but his was "valid"). Total knob.

respectfully, every nhs trust/healthboard varies in how things are done. What you’ve described might work for you but it’s not a good idea to assume it works the same in every region etc

if my GP called the ward they would tell me to go via A&e or the same day assessment ward that GPs can refer to- you don’t go straight to a ward such as respiratory, cardiology, gastrointestinal etc here. And it’s a good thing because half the time I don’t even need to be on the ward, once I’m stabilised I’m fine and can be seen as an outpatient if needed

and even if what you described was the case here- what do you suggest at midnight when the GP is closed?

Those lists are for people who come in multiple times a day! Or at least multiple times a week. I was once in A&E and the same guy came on 3 times just in the time I was waiting lol

The staff are quite aware of who needs to be there and who is coming for other reasons (loneliness, attention seeking, wanting a bed and food or whatever) if you medically need to be there don't worry

My MiL was a frequent Flyer, she has Alzheimer's and the associated falls, meant she needed hospital treatment as paramedics rarely arrived in time to get her on her feet without being checked into A &E . We were never made to feel uncomfortable by staff.

You have to be going to a&e very regularly to end up on the radar. But yes the person with health anxiety who turns up to a&e to that high frequency is certainly at significantly more risk of having a missed or delayed diagnosis when it is a blood clot.

If you go in to A&E with chest pain short of breath/I'm worried I'm having a heart attack for the first time you will get a very thorough work up, if initial tests are normal you'll be kept for monitoring and repeat of tests/more specialist tests should initial testing not evidence a diagnosis.

If a person presents with those same symptoms, however it's his 60th attendance that year for chest pain short of breath, for which there's never any cause found/presumed anxiety when all other testing normal - then they may well be a plan in place that means they just receive initial basic tests then discharge to GP.

We all know at some point these patients will have something genuine, because at some point illness comes to us all - so differences from their typical presentation will be considered.

I work for the ambulance service and we put plans in place for regulars. There are some who can call and report they cannot breath, have chest pain and feel like they're going to die - but we don't even respond in an ambulance just give them a call back every 2 hours until they cancel. To get to this place though these people have been calling multiple times a day - getting taken to A&E and on returning home call 999 again. These people will have absolutely led to the harm and deaths to others in the delaying of their care and that's why the plans go in place to try and limit how much they harm they cause.

From an NHS doctor- this is absolutely crazy. Where do you live that there is this level of resource?

There are no beds for GPs to admit to- even if you ring the speciality and the admission is agreed you end up in A&E awaiting a bed.
You can't just show up willy nilly in the hospital with no one expecting you. Clinics are already overbooked with a years waiting list for routine. The specialist nurse can have a role but this is very specific and protocol driven- any significant deterioration and they will advise A&E.

At one point a few years ago I was classed as a frequent user I never went of my own accord. It was police/crisis team/ CMHT or after an attempt on my own life where I wasn’t conscious.
i requested my notes a while ago and it was honestly quite horrible some of the comments in the notes by some staff.
One particular nurse was always quite horrible and had no time for any MH patients until once when I was brought back in resus she sat with me till my husband could get there.
i understand frequent fliers are a pain especially when there’s nothing that can tangibly be done in MH cases it’s basically a sticking plaster

Where I work (non-UK), yes, we also make "frequent presenter" plans for some patients with genuine medical conditions. It serves multiple purposes:

1. Saves staff who haven't met the patient before from wasting time trawling through months/years of notes to understand the situation

2. Expedites treatment and disposition by having a clear plan for specific symptoms already documented. In some cases, there may be a standing agreement from an inpatient service to directly admit the patient

3. Prevents over-investigation of already-investigated conditions and its attendant risks, especially when there is a psychosomatic component to the presentations (this is often, although not always, the case when someone repeatedly presents to emergency for a chronic condition)

4. Triggers involvement of other services that may be able to prevent or reduce hospital attendance e.g. we have teams who can do home visits for some chronic conditions, including management of exacerbations in certain circumstances

In some cases, we would also share these plans with other hospitals in the area. We do very occasionally issue a "not welcome" order to an individual, preventing them from attending our department again, but only in the context of repeated aggressive, violent, or otherwise antisocial behaviour requiring police attendance to the department (sadly, not uncommon where I work).

You cant where i am - Major trauma Hospital

I ALWAYS have to go to A&E

I see a consultant in that specif area, Renal, Gastro, Neuro

But i have never been admitted straight onto a ward, often because doctors arent always on wards, especially at 3am
Wards dont ‘stablise’ you or routinely offer ‘Emergency treatment’

Just because your hospital works like this
It doesnt mean its the same everywhere

AND it is not unusual to have a well managed chronic condition and still need to go to A&E often and basically saying that people like me and the OP’s conditions cant be well managed is frankly rather insulting

I work in mental health and some our patients have court orders/ bans around their use of emergency services or A&E attendance. 6 times in a year is nothing, especially as you require treatment when you go.

This must be a regional thing. I have had a chronic illness for almost two decades and every time I speak to my consultant when things get bad and they think I’ll need long-term treatment, I’m told to come in through a&e. The only time I haven’t is when it has been a booked surgical procedure.

How does that work if they need A&E for something physical?

They will likely flag it, but not as a time waster. It will be flagged that the appropriate department isn't managing your condition adequately.

My dd was a frequent attender with her asthma at one point - until they gave her montelukast and she hasn’t been since! That’s about 8 years ago I think. Only gave it to her when the headteacher commented on her absences though…

DS has been a bit injury prone but hoping it’s not enough that he’s on the list - every time it’s been a sprain that we needn’t have gone in for (nearly always sustained at school ) but he’ll make you think it’s broken… He’ll be almost radioactive soon.

Don't worry 6 times in a year is not a frequent flyer! I've met several patients that attend daily. And even if it was in reality those plans are about helping the person use more appropriate services and actually get help that they can't get in a&e not to punish patients.