Description 

High utilizers of the healthcare system are a particular subset of patients that are subject to a high risk of provider bias. Whether it is a patient that presents to the emergency department several times per week or a patient who is well known for their low-dose overdoses that is being seen after a brief stint in the ICU, their reputations predate them, and these preconceived beliefs could adversely affect their care. Part 1: “The Woman Who Cried Wolf.” The chair speaker will present the case of a high utilizer in the emergency department who ultimately died by suicide and the factors that contributed to this outcome. They will explore the sentinel event that resulted in a system wide training to raise awareness about provider bias and instant countertransference towards high utilizers. This presentation will highlight the patients most at risk for provider bias- including racial, social, and socioeconomic factors, the potential legal implications of high-risk discharges, and strategies for mitigating risk while maintaining optimal patient care. Part 2: “The Calm Before the Storm.” The speaker will present a case of a patient with a longstanding psychiatric history with a sustained period of stability prior to an acute deterioration that proved to be fatal. They will discuss how patient presentations can be minimized by care providers across the system from EMS to the ICU. They will highlight strategies for looking past chronic mental illness to identify true medical concerns. They will discuss the different types of bias that contributed to a delay in care including confirmation bias, blind spot bias, and conservatism bias. Part 3: “I Can’t Spend All Day on This.” The speaker will present a well-known situation of a high utilizer who seeks hospitalization and medications from various providers often to their own detriment. They will focus in on the impact not only to the patient but the strain on the system and providers that this can cause. They will explore strategies for minimizing system strain and burnout. Part 4: “Choose Your Own Adventure.” Our discussant will lead the audience through several scenarios with audience polling deciding the next steps in care. They will summarize techniques to combat instant countertransference, mitigating risk for an exceptionally high-risk group of patients, and skills for combating patient specific burnout. The discussant will conclude the session with a brief question and answer panel.

Format 

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. Define instant counter transference and how this can negatively impact high utilizers of the medical system.
2. Identify demographics, diagnoses, and other risk factors that can put patients at high risk for high utilization of the medical system.
3. Define the common types of bias that affect high utilizers of the medical system.
4. Become familiar with strategies to identify bias, mitigate negative effects of provider bias, optimize care for high utilizers of the medical system and minimize system and provider strain.
5. Navigate the potential legal implications of high-risk discharges and how to mitigate both legal risk and minimize risk to the patient.

Target Audience 

Residents/Fellows, Psychiatrists, Psychologists

Estimate Time to Complete 

Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Instructors 

• Kelley- Anne Klein, MD
• Raunak Khisty, MD, MPH, FAPA
• Sahil Munjal, MD
• James Kimball, MD

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance