Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

Abstract

Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

Emergency department utilization and hospitalizations for ambulatory care sensitive conditions among unattached people actively seeking a primary care provider during the COVID-19 pandemic: a retrospective cohort study

“…Regardless, multiple Canadian studies have found that females are more likely to be frequent users of EDs. (27–29) Consistent with our findings, Canadian data indicate that males and older people have a greater number of ACSC hospitalizations than females and younger people, respectively. (30–32).…”

“…Regardless, multiple Canadian studies have found that females are more likely to be frequent users of EDs. (27)(28)(29) Consistent with our findings, Canadian data indicate that males and older people have a greater number of ACSC hospitalizations than females and younger people, respectively.(30-32). This was true for older people "on-" and "off-Registry", suggesting that current primary care models may be less effective in avoiding these types of admissions, regardless of attachment status.…”

Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study

“…These patients were more commonly admitted to hospital; however, although emergency department visits were of higher acuity in Ontario compared to nonfrequent controls, they were of lower acuity in Alberta, similar to previous analyses. 45 This finding may indicate that social complexities (e.g., unstable housing or older patients failing to thrive in unsupported home environments) or lack of community follow-up to enable safe discharge may influence admission decisions.…”

People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study

“…Consistent with previous studies, we identified that frequent use is most often short-term. 10,35,36 Associations between persistent frequent use and increasing comorbidity, mental health, substance use and homelessness could indicate predispositions to medical complications, return visits seeking more compassionate treatment 37 or gaps in effectual alternatives to emergency department care (e.g., primary or addictions care), in rural areas for instance.…”