When an uninsured patient visits an emergency department (ED), but requires follow-up care, there are not always affordable options. Often, these patients will visit a second ED to receive the follow-up care they need, resulting in duplicate visits for the same injury. Baylor College of Medicine’s Dr. Laura Medford-Davis set out to determine whether these duplicate visits are self-referred or the result of a referral from another ED, and their consequences. The research appeared in the journal Academic Emergency Medicine.

“In Houston, we have a lot of uninsured patients who have trouble getting all of the care they need, so they visit multiple emergency departments trying to get care,” said Medford-Davis, assistant professor of emergency medicine at Baylor. “We want to be sure patients are receiving the best care possible, but we know that duplicate visits can take a toll on them, taking time away from work or resulting in delayed care. My hope is that this research gives us some insight as to where these referrals are coming from in order to better address the issue at the source.”

The research looked at 143 patients at a public hospital in Texas who were identified as duplicate visits. Of these cases, 94 percent were uninsured, 61 percent presented to the public hospital’s ED with a fracture, 27 percent required admission to the ED and 95 percent of those discharged required further outpatient follow-up care.

The research team surveyed 51 of these patients and conducted interviews with 23 fracture patients. In this group, more than half of the patients were indirectly referred, or told by staff at the initial hospital to visit the second public ED for follow-up, and 23 percent were referred to the public ED for additional care by a follow-up physician associated with the initial hospital.

Overall, 73 percent of the patients presenting to the public hospital ED for the same complaint were referred without the transfer of paperwork or records, thereby requiring the second ED to perform the same tests a second time. “Duplicating these tests causes increased anxiety in patients and diverts resources from other ED patients, not to mention creates additional costs,” said Medford-Davis. “While many of the patients we surveyed presented with fractures, other serious, time-sensitive complaints, such as kidney dialysis, cancer care and a bleed on the brain, came in this way.”

Medford-Davis notes that the research reveals a dire need for these uninsured patients to have access to follow-up care they can afford and that the complicated process to receive it has significant psychological impacts. “Our healthcare system and our city need to decide how these patients will be provided for when it comes to follow-up care, which is not an easy task. I hope this research sheds light on the frequency at which these patients are receiving duplicate care and will help guide a discussion on how we can work to improve the process,” said Medford-Davis.