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. 2018 Jul 5;18(1):157.
doi: 10.1186/s12877-018-0854-8.

Repeat emergency department visits by nursing home residents: a cohort study using health administrative data

Andrea Gruneir  1 , Candemir Cigsar  2 , Xuesong Wang  3 , Alice Newman  3 , Susan E Bronskill  3 , Geoff M Anderson  4 , Paula A Rochon  5
Affiliations

Repeat emergency department visits by nursing home residents: a cohort study using health administrative data

Andrea Gruneir et al. BMC Geriatr. .

Abstract

Background: Nursing home (NH) residents are frequent users of emergency departments (ED) and while prior research suggests that repeat visits are common, there is little data describing this phenomenon. Our objectives were to describe repeat ED visits over one year, identify risk factors for repeat use, and characterize "frequent" ED visitors.

Methods: Using provincial administrative data from Ontario, Canada, we identified all NH residents 65 years or older who visited an ED at least once between January 1 and March 31, 2010 and then followed them for one year to capture all additional ED visits. Frequent ED visitors were defined as those who had 3 or more repeat ED visits. We used logistic regression to estimate risk factors for any repeat ED visit and for being a frequent visitor and Andersen-Gill regression to estimate risk factors for the rate of repeat ED visits.

Results: In a cohort of 25,653 residents (mean age 84.5 (SD = 7.5) years, 68.2% female), 48.8% had at least one repeat ED visit. Residents who experienced a repeat ED visit were generally similar to others but they tended to be slightly younger, have a higher proportion male, and a higher proportion with minimal cognitive or physical impairment. Risk factors for a repeat ED visit included: being male (adjusted odds ratio 1.27, (95% confidence interval 1.19-1.36)), diagnoses such as diabetes (AOR 1.28 (1.19-1.37)) and congestive heart failure (1.26 (1.16-1.37)), while severe cognitive impairment (AOR 0.92 (0.84-0.99)) and 5 or more chronic conditions (AOR 0.82 (0.71-0.95)) appeared protective. Eleven percent of residents were identified as frequent ED visitors, and they were more often younger then 75 years, male, and less likely to have Alzheimer's disease or other dementias than non-frequent visitors.

Conclusions: Repeat ED visits were common among NH residents but a relatively small group accounted for the largest number of visits. Although there were few clear defining characteristics, our findings suggest that medically complex residents and younger residents without cognitive impairments are at risk for such outcomes.

Keywords: Emergency; Long-term care; Recurrent events; Repeated events; Transfers.

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Conflict of interest statement

Ethics approval and consent to participate

ICES is a prescribed entity under section 45 of Ontario’s Personal Health Information Protection Act. Section 45 authorizes ICES to collect personal health information, without consent, for the purpose of analysis or compiling statistical information with respect to the management of, evaluation or monitoring of, the allocation of resources to or planning for all or part of the health system. Projects conducted under section 45, by definition, do not require review by a Research Ethics Board. This project was conducted under section 45 and approved by ICES’ Privacy and Compliance Office. The study received approval from the Research Ethics Board at Women’s College Hospital, Toronto, Canada. This study was approved by the institutional review board at Sunnybrook Health Sciences Centre in Toronto, Canada.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

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Fig. 1
Cohort development and timeline
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