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1 in 5 emerg dept trips could be treated elsewhere; many during business hours

11/06/2014 04:25 EST | Updated 01/06/2015 05:59 EST
TORONTO - As many as one in five of all visits to hospital emergency departments are for things that could probably be dealt with better elsewhere, a new report says.

The report from the Canadian Institute for Health Information, released Thursday, said 20 per cent of emergency department traffic is for minor medical conditions that don't require hospitalization. Many and perhaps most of those medical needs could be better treated by a family doctor or in a community clinic, the report suggested.

Family physicians can provide better continuity of care and visiting them is often less stressful than going to a hospital emergency department, said Kathleen Morris, CIHI's director for health system analysis and emerging issues.

Morris said the level of care in emergency departments is high, and someone going to one might get the same treatment as he or she would get from his or her family doctor.

But the family doctor knows the context of the case, which can lead to different treatment recommendations. She used as an example someone going to the emergency department for a sore throat.

"But what would be missing in the ED is understanding that sore throat as part of a pattern of care," Morris said.

"And if it's just a one-off incident it's probably not a big deal. If it's the sixth or seventh severe throat infection in a year, then a family doctor might actually be considering some different options ... like removing your tonsils."

Interestingly, 43 per cent of the visits for minor medical conditions occurred during working hours, which Morris admitted came as a surprise.

A survey done in conjunction with the study found that nearly half of people said they could not get in to see their doctor in a timely manner.

"It could be thought that while a physician may be working hard that day, a patient may not be able to get an appointment as quickly as they would like," she said.

"But I think it highlights for us there has to be some room for improvement in that particular area."

Children under five years of age made up a big portion of these medical visits to emergency departments, with upper respiratory tract and ear infections being the most common reasons for their visits.

The report also said one in three seniors living in long-term care facilities made a visit to an emergency department in 2012-13, and about a third of those visits were avoidable.

That's another area that could probably use improvement, Morris said, noting that many seniors have complex medical problems and may be on a variety of medications. That means a lot of information must accompany the senior to the hospital, and updated information should accompany him or her home. But that doesn't always happen, she said.

"What we know from so many other pieces of work is that every transition in care heightens the opportunity for some information to fall through the tracks."

She suggested the report is a good opportunity for long-term care facilities to review their practices for when to transfer patients to the emergency department with an eye to reducing how often this happens.

They could put in place things like standing orders, she said, where doctors authorize nursing staff to commence use of an antibiotic or order a test if a patient's condition reaches a certain point.

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