BEYOND THE WEEKLY CENSUS:

1. BEYOND THE WEEKLY CENSUS: A CLOSER LOOK AT PATIENT FACTORS CONTRIBUTING TO EMERGENCY ROOM USE IN WINNIPEG Romy McMaster, BSc (MSc Candidate), Anita Kozyrskyj, PhD (Advisor) Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada RATIONALE RESULTS CONCLUSION This study showed that, beyond simple visit counts, variation exists across emergency departments in Winnipeg, across age groups, and across geographic boundaries. Urgency, admit rates and lengths of stay increase dramatically with age. Each year, approximately 200,000 visits are made to Adult Emergency Departments in Winnipeg. The Winnipeg Regional Health Authority publishes a weekly visit count by hospital, but little else is reported. What is known about these emergency patients? Average Daily Number of Visits Per Hospital Fiscal 01/02 Geographic Distribution of Emergency Department Visits Visit Rate per 1000 population All Age Groups Number of Visits By Age Group At Each Hospital Fiscal 01/02 – Scheduled Visits Excluded OBJECTIVE To describe variation in emergency room use and to identify patient factors that contribute to Emergency Department workload in Winnipeg. Legend: Visits Per 1000 Population POLICY IMPLICATIONS & RECOMMENDATIONS Use of this database could address research and policy questions such as: Q: What is the rate of early return visits (i.e. within 72 hours) and what are the outcomes of these patients? Q: Are Emergency Department (ED) users loyal to one ED? Q: What is the average distance (i.e. travel time) to the ‘most frequently used’ ED? Q: What is the rate of ED registrants leaving without being seen by a physician? Q: How does ED use vary over time? Q: What is the effect of opening primary health care centres or urgent care centres on ED use? Q: How does a changing demographic alter the use of EDs in Winnipeg? Visit Rate per 1000 population Ages 65+ METHODS • This descriptive study used data systematically collected from all six Adult Emergency Departments in Winnipeg from April 1, 2001 - March 31, 2002. • Variables available for each emergency room registrant included: • Personal Health Information Number (PHIN) • Date of birth • Triage level • Registration date and time • Discharge date and time • Discharge status • Postal code • (Data from Children’s Emergency and Misericordia Urgent Care Centre were not available, although visits made by children to adult emergency departments were included) Proportion of Visits by Triage By Age Group Fiscal 01/02 – All Hospitals Ages 17-44 Ages 85+ Linking this database to other information, including hospital abstracts and physician claims, could address research and policy questions such as: Q: Are frequent users of the ED frequent users of other health care services? Q: What is the pattern of ED use of patients when their regular physician is unavailable (i.e. after office hours)? Q: Are there certain chronic diseases or comorbidities that increase the likelihood of utilization of the ED? Q: How does ED use vary by income and other measures of socioeconomic status? Length of Stay in Hours (From Registration to Discharge) Fiscal 01/02 “Other” category includes invalid entries, resuscitation and direct admits Admit Rates By Age Group Fiscal 01/02 ACKNOWLEDGEMENTS This training opportunity was supported (in part) by a Western Regional Training Centre studentship funded by a Canadian Health Services Research Foundation, Alberta Heritage Foundation for Medical Research and Canadian Institutes of Health Research Due to unreliable information on the discharge status field from Seven Oaks General Hospital (SOGH), it was not included in the analysis I would also like to acknowledge the support and guidance of Mr. Randy Martens, Administrative Director of the Winnipeg Regional Health Authority Emergency & Critical Care Programs. CGH = Concordia General Hospital / GGH = Grace General Hospital / HSC = Health Sciences Centre / SBGH = St. Boniface General Hospital / SOGH = Seven Oaks General Hospital / VGH = Victoria General Hospital