An Emergency Department and Emergency Medical Services Superutilizer – A Case Report of a Multidisciplinary Approach to Resolution

Frequent emergency department (ED) visitors, referred to as high-need, high-cost, or "superutilizers," are a challenging population for the health care system. Superutilizers account for a disproportionate share of overall health care spending (5% of the population accounts for 50% of health care spending) and have therefore been a focus of research and intervention over the past decade. Although ED superutilizers have been described previously, we report a case that demonstrates the additional strain on the emergency medical services (EMS). A 65-year-old woman was the highest 9-1-1 caller for a major metropolitan area, averaging 1.6 transports per day. Identifying the root causes of a patient's frequent utilization can be difficult and sometimes requires stepping back, gaining a fresh perspective, or returning to basic questions, including "why is this patient failing home therapy?" In this case, undetected cognitive impairment was a significant contributor to her frequent utilization. A hospital/EMS paramedicine partnership facilitated detection and care for this root cause and stopped the frequent ED and 9-1-1 use. This case highlights the impact of superutilizers on EMS, the promising role of intervention teams, and the complexity of cognition/capacity determination in the ED.