Habitually wandering patients

Physicians are sometimes confronted with patients who gain admission to one hospital after another, sometimes referred to as "wandering patients." Little is known about the presenting symptoms of these patients, their use of hospital resources, or the costs of their medical care. We analyzed the demographic and clinical characteristics of wandering patients served by Department of Veterans Affairs medical centers (VAMCs).

For each patient they admit, all 159 hospitals in the Veterans Affairs medical system submit demographic and diagnostic information to a central data base at the Data Processing Center in Austin, Texas. We searched these records to identify patients who were admitted to four or more VAMCs within each year from fiscal year 1988 through 1992. Patients so identified in any one year were called "wanderers"; those identified in all five years were designated "habitual wanderers."

We identified 1013 wanderers in 1988. The number gradually declined each year to 729 in 1993. In 1991 there were 810 wandering patients, who averaged about eight admissions per year and over 100 days of inpatient care; they accounted for about $26.5 million in costs for inpatient and outpatient care in that year. Only 35 patients wandered in all five years from 1988 through 1992. The most common discharge diagnoses of these 35 men were related to substance abuse (mostly alcoholism) and mental disorders. Their 2268 admissions and 7832 outpatient visits cost an estimated $6.5 million over the five-year period.

Patients who are repeatedly admitted to different hospitals--wandering patients--accumulate high numbers of admissions, cause diagnostic confusion, and receive uncoordinated care. Because of the complexity of their disorders, such patients require case management on a regional or national basis.