Frequency and Pattern of Emergency Department Visits by Long-Term Care Residents-A Population-Based Study

OBJECTIVES To obtain population-based estimates of emergency department (ED) visits by long-term care (LTC) residents. DESIGN Retrospective cohort study using administrative data. SETTING All LTC facilities in Ontario, Canada. PARTICIPANTS All LTC residents who visited an ED at least once during a 6-month period. MEASUREMENTS All ED visits were described using the National Ambulatory Care Reporting System. Two distinct visit types were defined. Potentially preventable visits were defined as those for any ambulatory care sensitive condition; these are conditions for which exacerbations that result in hospital use suggest lack of access to adequate primary care. Low-acuity visits were defined as those triaged as nonurgent at ED registration and ended with return to the LTC facility without hospital admission. RESULTS Nearly one-quarter of LTC residents visited the ED at least once in 6 months. Of all visits, 24.6% were for a potentially preventable reason, most commonly pneumonia, urinary tract infection, and congestive heart failure. These visits had a high frequency of ambulance transport (90.4%), emergent triage (35.3%), hospital admission (62.4%), and death within 30 days (23.6%). Of all visits, 11.0% were low acuity. Fall-related injury was the most common cause. Low-acuity visits were the shortest (mean length 4.5 +/- 4.0 hours) and had the lowest frequency of death within 30 days (4.3%). CONCLUSION LTC residents made frequent visits to the ED. The visit types showed distinct patterns that suggest a need for better access to medical care for common conditions and a greater emphasis on fall prevention in LTC.