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Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study
Frequent users to emergency departments (EDs) are a diverse group of patients with high numbers of ED presentations. This study compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario, Canada.
Annual cohorts of HSUs were created for Alberta and Ontario 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 April 2011 to March 2016. Random samples of patients not in the HSU groups were selected in each province as controls (4:1 ratio). Presentation (e.g., acuity measured by the Canadian Triage and Acuity Scale [CTAS]) 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.
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 emergent (CTAS 2) level whereas Alberta had 11-15%. Time to PIA was similar across provinces and groups (medians of 60min to 67min). Lengths of stay were longest for Ontario HSUs (median=3h) and shortest for Alberta HSUs (median=2.2h). HSUs had shorter times to PIA (hazard ratio [HR]=1.02; 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).
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.
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