Demographic, emergency department use and hospitalization characteristics for people who made frequent emergency department visits from Apr. 1, 2015, to Mar. 31, 2016, by persistent frequent use subgroup — Ontario
| Characteristic | Subgroup: no. of study years in which the definition of frequent emergency department use was met | ||||
|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |
| No. of patients (% of total) | 112048 (44.3) | 62813 (24.9) | 37338 (14.8) | 23397 (9.3) | 17141 (6.8) |
| No. of patients whose frequent emergency department use spanned consecutive yr (%) | – | 27868 (44.4) | 12807 (34.3) | 9068 (38.8) | 17141 (100.0) |
| Patient characteristics (NACRS metadata) | |||||
| Gender, n (%) | |||||
| Female | 58617 (52.3) | 34887 (55.5) | 21713 (58.2) | 14265 (61.0) | 10807 (63.0) |
| Male | 53430 (47.7) | 27924 (44.5) | 15624 (41.8) | 9132 (39.0) | 6333 (36.9) |
| Other | 1 (0.0) | 2 (0.0) | 1 (0.0) | 0 (0.0) | 1 (0.0) |
| Age, yr, median (IQR) | 53 (33–71) | 53 (33–71) | 52 (33–71) | 50 (33–68) | 48 (34–63) |
| Rural or urban, n (%) | |||||
| Rural | 22365 (20.0) | 13798 (22.0) | 8478 (22.7) | 5505 (23.5) | 3994 (23.3) |
| Urban | 89266 (79.7) | 48651 (77.5) | 28547 (76.5) | 17645 (75.4) | 12827 (74.8) |
| Not available | 417 (0.4) | 364 (0.6) | 313 (0.8) | 247 (1.1) | 320 (1.9) |
| Weighted Charlson Comorbidity Index, n (%) | |||||
| 0 | 90259 (80.6) | 48656 (77.5) | 27898 (74.7) | 17300 (73.9) | 12211 (71.2) |
| 1 | 14820 (13.2) | 10077 (16.0) | 6979 (18.7) | 4546 (19.4) | 3753 (21.9) |
| 2 | 4756 (4.2) | 2877 (4.6) | 1774 (4.8) | 1130 (4.8) | 847 (4.9) |
| 3 | 961 (0.9) | 663 (1.1) | 431 (1.2) | 285 (1.2) | 223 (1.3) |
| 4+ | 1252 (1.1) | 540 (0.9) | 256 (0.7) | 136 (0.6) | 107 (0.6) |
| No. of emergency department visits per person, median (IQR) | 4 (4–6) | 5 (4–6) | 5 (4–7) | 6 (4–8) | 7 (5–11) |
| Emergency department visit characteristics (NACRS metadata) | |||||
| No. of emergency department visits (% of total) | 583092 (37.9) | 362668 (23.6) | 238976 (15.5) | 171694 (11.2) | 183162 (11.9) |
| Arrival by ambulance, n (%) | |||||
| Air ambulance | 97 (0.0) | 54 (0.0) | 34 (0.0) | 49 (0.0) | 59 (0.0) |
| Air and ground ambulance | 313 (0.1) | 263 (0.1) | 193 (0.1) | 114 (0.1) | 105 (0.1) |
| Ground ambulance | 106309 (18.2) | 76772 (21.2) | 55184 (23.1) | 40820 (23.8) | 49225 (26.9) |
| No ambulance | 476373 (81.7) | 285579 (78.7) | 183565 (76.8) | 130711 (76.1) | 133773 (73.0) |
| Triage level (CTAS), n (%) | |||||
| 1 (resuscitation) | 5404 (0.9) | 3406 (0.9) | 2224 (0.9) | 1544 (0.9) | 1632 (0.9) |
| 2 (emergent) | 119647 (20.5) | 76365 (21.1) | 50578 (21.2) | 35773 (20.8) | 38922 (21.3) |
| 3 (urgent) | 266440 (45.7) | 163842 (45.2) | 108364 (45.3) | 77876 (45.4) | 83289 (45.5) |
| 4 (less urgent) | 157088 (26.9) | 94601 (26.1) | 61756 (25.8) | 44772 (26.1) | 46266 (25.3) |
| 5 (nonurgent) | 31488 (5.4) | 20583 (5.7) | 13897 (5.8) | 10006 (5.8) | 11466 (6.3) |
| Unknown | 2506 (0.4) | 3456 (1.0) | 1873 (0.8) | 1491 (0.9) | 1253 (0.7) |
| Not available | 519 (0.1) | 415 (0.1) | 284 (0.1) | 232 (0.1) | 334 (0.2) |
| Alcohol-related visit, n (%) | |||||
| Yes | 4948 (0.8) | 5387 (1.5) | 5654 (2.4) | 5486 (3.2) | 9873 (5.4) |
| No | 578144 (99.2) | 357281 (98.5) | 233322 (97.6) | 166208 (96.8) | 173289 (94.6) |
| Substance use–related visit, n (%) | |||||
| Yes | 7343 (1.3) | 7773 (2.1) | 7806 (3.3) | 7222 (4.2) | 11 748 (6.4) |
| No | 575749 (98.7) | 354895 (97.9) | 231170 (96.7) | 164472 (95.8) | 171414 (93.6) |
| Top 5 ICD-10-CA emergency department diagnoses, n (%) | |||||
| 1 | Drug therapies 25570 (4.4) | Abdominal pain 12194 (3.4) | Abdominal pain 8453 (3.5) | Abdominal pain 7056 (4.1) | Abdominal pain 9150 (5.0) |
| 2 | Abdominal pain 18609 (3.2) | Drug therapies 11110 (3.1) | UTI 7187 (3.0) | UTI 4956 (2.9) | Chest pain 5559 (3.0) |
| 3 | UTI 14799 (2.5) | UTI 10829 (3.0) | Drug therapies 5843 (2.4) | Chest pain 4509 (2.6) | Alcohol intoxication 5000 (2.7) |
| 4 | Chest pain 12142 (2.1) | Chest pain 8651 (2.4) | Chest pain 5792 (2.4) | Drug therapies 3485 (2.0) | UTI 4798 (2.6) |
| 5 | Cellulitis of lower limb 10178 (1.7) | Cellulitis of lower limb 5787 (1.6) | COPD 3576 (1.5) | COPD 2631 (1.5) | Drug therapies 3610 (2.0) |
| Visit disposition, n (%) | |||||
| Discharged | 465571 (79.8) | 287842 (79.4) | 189881 (79.5) | 137287 (80.0) | 147860 (80.7) |
| Transferred or admitted | 94122 (16.1) | 57491 (15.9) | 35777 (15.0) | 23383 (13.6) | 20504 (11.2) |
| Left against medical advice | 23127 (4.0) | 17159 (4.7) | 13210 (5.5) | 10976 (6.4) | 14745 (8.1) |
| Died | 272 (0.0) | 176 (0.0) | 108 (0.0) | 48 (0.0) | 53 (0.0) |
| Hospitalization characteristics (DAD metadata) | |||||
| No. of patients with at least 1 admission, n (%) | 43548 (38.9) | 24536 (39.1) | 14465 (38.7) | 8948 (38.2) | 6717 (39.2) |
| No. of admissions | 84784 | 50951 | 31194 | 20212 | 16672 |
| No. of admissions per person, median (IQR) | 2 (1–2) | 2 (1–3) | 2 (1–3) | 2 (1–3) | 2 (1–3) |
| Time admitted, d, median (IQR) | 4 (2–8) | 4 (2–7) | 4 (2–7) | 3 (2–7) | 3 (2–6) |
| Top 5 ICD-10-CA primary diagnoses, n (%) | |||||
| 1 | CHF 3865 (4.6) | CHF 2826 (5.5) | CHF 1774 (5.7) | COPD 987 (4.9) | COPD 751 (4.5) |
| 2 | UTI 1950 (2.3) | COPD 1642 (3.2) | COPD 1474 (4.7) | CHF 984 (4.9) | CHF 610 (3.7) |
| 3 | Pneumonia 1715 (2.0) | UTI 1453 (2.9) | COPD and respir. infection 954 (3.1) | COPD and respir. infection 632 (3.1) | COPD and respir. infection 453 (2.7) |
| 4 | COPD 1691 (2.0) | Pneumonia 1167 (2.3) | UTI 923 (3.0) | UTI 586 (2.9) | UTI 452 (2.7) |
| 5 | Myocardial infarction 1627 (1.9) | COPD and respir. infection 1162 (2.3) | Pneumonia 684 (2.2) | Pneumonia 461 (2.3) | Alcohol, withdrawal 353 (2.1) |
| Top 5 ICD-10-CA primary diagnosis chapters, n (%) | |||||
| 1 | Circulatory 15152 (17.9) | Circulatory 8663 (17.0) | Circulatory 4891 (15.7) | Circulatory 2887 (14.3) | Circulatory 1951 (11.7) |
| 2 | Respiratory 8640 (10.2) | Respiratory 6679 (13.1) | Respiratory 4700 (15.1) | Respiratory 3062 (15.1) | Respiratory 2357 (14.1) |
| 3 | Digestive 12393 (14.6) | Digestive 6904 (13.6) | Digestive 4158 (13.3) | Digestive 2707 (13.4) | Digestive 2111 (12.7) |
| 4 | Abnormal clinical findings 7671 (9.0) | Abnormal clinical findings 5027 (9.9) | Abnormal clinical findings 3230 (10.4) | Abnormal clinical findings 2222 (11.0) | Abnormal clinical findings 2098 (12.6) |
| 5 | Injury, poisoning 7780 (9.2) | Injury, poisoning 4436 (8.7) | Injury, poisoning 2608 (8.4) | Injury, poisoning 1768 (8.7) | Injury, poisoning 1506 (9.0) |
| Discharge disposition, n (%) | |||||
| Transferred to another facility | 4748 (5.6) | 2629 (5.2) | 1493 (4.8) | 981 (4.9) | 752 (4.5) |
| Transferred to a long-term care facility | 8749 (10.3) | 5708 (11.2) | 3319 (10.6) | 1924 (9.5) | 1249 (7.5) |
| Transferred to other centre | 833 (1.0) | 524 (1.0) | 351 (1.1) | 235 (1.2) | 201 (1.2) |
| Discharged to a home setting with support services | 26146 (30.8) | 16740 (32.9) | 9943 (31.9) | 6086 (30.1) | 4572 (27.4) |
| Discharged home | 39714 (46.8) | 22332 (43.8) | 14103 (45.2) | 9639 (47.7) | 8546 (51.3) |
| Signed out against medical advice | 1017 (1.2) | 910 (1.8) | 834 (2.7) | 717 (3.5) | 994 (6.0) |
| Died | 3572 (4.2) | 2106 (4.1) | 1148 (3.7) | 628 (3.1) | 355 (2.1) |
| Did not return from pass | 5 (0.0) | 2 (0.0) | 3 (0.0) | 2 (0.0) | 3 (0.0) |
| Mental health hospitalization–related characteristics (HMHDB metadata) | |||||
| No. of patients with at least 1 mental health–related admission, n (% of total) | 6004 (5.4) | 4543 (7.2) | 3155 (8.4) | 2218 (9.5) | 2124 (12.4) |
| No. of mental health–related admissions | 9876 | 7925 | 5757 | 4233 | 4754 |
| Documented homelessness among patients with at least 1 mental health–related admission, n (%) | |||||
| Yes | 225 (3.7) | 259 (5.7) | 193 (6.1) | 151 (6.8) | 214 (10.1) |
| No | 5779 (96.3) | 4284 (94.3) | 2962 (93.9) | 2067 (93.2) | 1910 (89.9) |
| Length of hospital stay, d median (IQR) | 7 (3–16) | 7 (2–16) | 6 (2–15) | 5 (2–13) | 4 (2–12) |
| Diagnosis category, n (%) | |||||
| Substance-related disorder | 1659 (16.8) | 1629 (20.6) | 1422 (24.7) | 1112 (26.3) | 1355 (28.5) |
| Mood disorder | 2885 (29.2) | 2338 (29.5) | 1477 (25.7) | 1086 (25.7) | 1123 (23.6) |
| Schizophrenic and psychotic disorder | 2059 (20.8) | 1639 (20.7) | 1347 (23.4) | 981 (23.2) | 1003 (21.1) |
| Organic disorder | 1584 (16.0) | 1067 (13.5) | 570 (9.9) | 327 (7.7) | 203 (4.3) |
| Other mental health disorder | 866 (8.8) | 555 (7.0) | 393 (6.8) | 291 (6.9) | 382 (8.0) |
| Personality disorder | 328 (3.3) | 315 (4.0) | 283 (4.9) | 269 (6.4) | 509 (10.7) |
| Anxiety disorder | 451 (4.6) | 330 (4.2) | 233 (4) | 145 (3.4) | 162 (3.4) |
| Non–mental health disorder | 35 (0.4) | 41 (0.5) | 27 (0.5) | 20 (0.5) | 12 (0.3) |
| Unknown disorder | 9 (0.1) | 11 (0.1) | 5 (0.1) | 2 (0.0) | 5 (0.1) |
| Discharge disposition, n (%) | |||||
| Discharged home | 8178 (82.8) | 6405 (80.8) | 4580 (79.6) | 3408 (80.5) | 3750 (78.9) |
| Transferred | 1111 (11.2) | 878 (11.1) | 608 (10.6) | 416 (9.8) | 408 (8.6) |
| Died | 48 (0.5) | 27 (0.3) | 15 (0.3) | 10 (0.2) | 5 (0.1) |
| Signed out against medical advice | 146 (1.5) | 160 (2.0) | 187 (3.2) | 137 (3.2) | 199 (4.2) |
| Other* | 393 (4.0) | 455 (5.7) | 367 (6.4) | 262 (6.2) | 392 (8.2) |
Note: CHF = congestive heart failure, COPD = chronic obstructive pulmonary disease, CTAS = Canadian Triage and Acuity Scale, DAD = Discharge Abstract Database, ED = emergency department, HMHDB = Hospital Mental Health Database, ICD-10-CA = International Statistical Classification of Diseases and Related Health Problems, 10th revision, Canadian version, IQR = interquartile range, NACRS = National Ambulatory Care Reporting System, respir. = respiratory, UTI = urinary tract infection.
↵* Including homeless and other; applies to records from the Ontario Mental Health Reporting System.