Grant: Operating Grant

CONTEXT: Each year 12 million people visit an emergency department (ED) in Canada, with the highest rates among older persons. Some will be admitted to hospital, but many are discharged home. Between the extremes of admitted and discharged patients there are patients for whom both options are possible. Discharge from the ED avoids the high cost of a hospitalization, risk of a hospital-acquired infection, and of delirium and permanent decline in the elderly. However, in order to safely discharge these patients a system of care must be in place to ensure a prompt follow-up appointment with the family physician (FP) or specialist. Because this system is often unreliable, many patients are simply admitted to hospital. THE PROBLEM: With the aging of the population, ED visits are expected to accelerate. Using patients with atrial fibrillation (AF) as an example, it is estimated that AF in the population will increase by 250% by the year 2050. ED visits for AF increased by 88% from 1994 to 2006, and are expected to increase similarly for other chronic diseases as well. METHODS: Using databases that include all Ontario ED visits, we will identify older patients seen in an Ontario ED with 1 of 3 common cardiovascular diseases: AF, high blood pressure, and heart failure. We will identify a group of patients for whom emergency doctors would standardly recommend early follow-up care with either the FP or specialist. We will see how many of those patients actually saw a doctor within 3, 7, and 30 days of the ED visit. Next we will determine whether lack of follow-up was associated with a higher death rate, return ED visits, and taking recommended medications. IMPACT: The study results will provide the first scientific evidence as to whether the current system of care between the ED and FP is adequate. It will allow us to make informed decisions as we proceed to a future study to evaluate interventions that aim to improve the transition of care between the ED and the FP.