Using Data to Inform Appropriateness in Saskatchewan's Health Care System: A Snapshot of Low Acuity Emergency Department Use

Date
2017-06
Authors
Todd, Tara Nicole
Journal Title
Journal ISSN
Volume Title
Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract

Background Emergency department (ED) use for low acuity medical conditions is widely regarded as a contributor to health system inefficiency. Low acuity conditions are semi-urgent or non-urgent conditions that can safely withstand 60 to 120 minutes prior to physician initial assessment. Low acuity ED attendance diverts limited resources away from patients with urgent conditions and creates increased demand for ED services. Low acuity conditions can also accrue higher costs at EDs than alternative primary care centres due to greater resource consumption and higher specialist fees. Continuity of care is compromised when patients consult EDs for low acuity conditions that have complex or chronic attributes. The objective of this study is to analyse ED utilization data to inform policies that support appropriate use of health care services. Methods A sample of 69,782 Regina and Saskatoon ED visits in 2012-13 were analyzed using descriptive analyses. Demographic and socioeconomic characteristics of patients, availability of existing primary care services, main medical problems, time of ED registration, and service provider for ED visit was analyzed. A macro-level comparative analysis was applied to Regina and Saskatoon and a meso-level comparative analysis was applied to communities within Regina and Saskatoon. Results In 2012-13, in urban Saskatchewan, 48.5% of ED visits were for low acuity conditions. Males and females used EDs in nearly equal proportions. Patients aged 18-44 constituted the highest proportion of ED use, at 42% of total visits. Patients using EDs at the highest rate reside in the S7M postal code area in Saskatoon and S4P area in Regina. These areas obtained the lowest median income in each municipality. S7M and S4P also showed the highest rate of existing primary care services in their immediate postal code area. Seventy-three percent of visits occurred during daytime hours (9:00 am to 10:00 pm). Medical conditions presented were largely due to chronic ailments or other family practice sensitive conditions. In Regina EDs, emergency specialists served the majority of patients (76.8%), while in Saskatoon, service was distributed as follows: emergency specialists (34.5%), GPs (25.6%), pediatrics (11.8%), RNs (10.3%), and internal medicine (9.4%). Discussion The greatest proportion of patients seeking low acuity ED care reside in low-income neighbourhoods and the presence of existing primary care centres near a patient’s residence may not avert the use of EDs. As such, adding primary care services in low-income neighbourhoods may not reduce low acuity ED use. Innovative strategies are required to meet primary care needs outside of the walls of EDs. Policy options are presented that empower patients through health literacy, promote sustainability through economic efficiency by replacing high-cost ED care with lower-cost primary care, and ensure quality and continuity of care for patients who require services beyond the biomedical model observed in EDs.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Master of Public Policy in Health Systems Research, University of Regina. ix, 139 p.
Keywords
Citation
Collections