Another one of our frequent fliers came back to the hospital today. For those who aren't familiar with the term, it refers to individuals who come to the hospital on a regular basis. Sometimes it's due to exacerbation of a condition. Others come because they have a chronic condition such as HTN or DM they don't manage properly at home. Others come because they like the attention. One lady comes in every few months with complaints of hemiparesis, usually following some difficulty with her family. One man comes in when he thinks he took too much cocaine and will have another stroke.
The woman today was admitted with the same complaints she had during her admission two weeks ago. Her sister was with her during the admission. Nothing happened fast enough to make her sister happy. She was constantly pushing for the patient to be discharged. I work in a very large hospital. Nothing happens quickly there. Nonetheless that sister was determined to leave ASAP.
So now the patient is back. The first thing I asked her was how her outpatient therapy was going. She couldn't tell me. She never made an appointment. Instead I got a long, drawn-out explanation of why she hadn't seen the doctor. Apparently therapy wasn't very high on either of their priority lists. With a little therapy she can return to her prior functional status. It still could happen but I'm not putting money on it.
Thus the frequent flyer phenomena will continue. I'm guessing she probably wasn't too compliant with her meds either. She'll be back again and again until she has a much larger stroke and can no longer return home. I have very little to offer her. She'll be hospitalized a short time, which doesn't give me much time to accomplish anything. The best I could do was put her on caseload and request a RW be ordered for her at discharge.
In the last month we've had three others return to us for various reasons. Two of those came because a family member thought something was different. Neither of those patients were cognitively intact so they can't tell us if something has changed. I reassessed both. According to previous documentation their functional statuses were unchanged. Family members are usually the first to notice a difference. But really, after the third or fourth time wouldn't you think they'd learn what a real change is?
Most of the ones who come to the stroke unit are very pleasant. We always have a nice conversation while we're walking around. They update on how their families are doing, tell how things have been going. The evaluations are quick. I clear them to walk and sign off. The stroke team is happy because they can now discharge the patient. The patient is happy because he can go home in the near future. It all works out. Wouldn't it have been better to just stay home since things will be resolved in less than 24 hours?
To me there's a difference between those who come in with TIAs but think they're having a stroke. They take the warning for what it is and move on. If it was I who suddenly developed hemiparesis, I'd be en route to that ER as fast I could get going. So why do the other ones keep coming back? Maybe they associate security with being in a hospital. Maybe they want free room and board for a few days. It doesn't matter. They'll all be back.