Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study
- PDF / 1,232,618 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 73 Downloads / 218 Views
RESEARCH ARTICLE
Open Access
Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study Anqi Chen1, Scott Fielding2, X. Joan Hu3, Patrick McLane2,4, Andrew McRae5,6, Maria Ospina7,8 and Rhonda J. Rosychuk1,9,3*
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. Keywords: Emergency department, Frequent health service users, Patient flow
Background Frequent users of emergency departments (EDs) are a small number of patients who are responsible for a large proportion of ED presentations [1]. No uniformly accepted definition of a frequent ED user has been * Correspondence: [email protected] 1 Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada 9 Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta T6G 2G1, Canada Full list of author information is available at the end of the article
identified. Some authors have used definitions such as ≥4 [2], ≥5 [3], and ≥ 7 [4] within a 12 month period. Whatever the definition, frequent users are an important group to of patients because some frequent users may be able to receive more appropriate care in other health settings [5] (e.g. settings more equipped for the management of chronic conditions) and some believe these patients contribute to ED crowding [6]. A systematic review of adult frequent ED user
Data Loading...
