Grant: Operating Grant

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 most are discharged home. There are some patients for whom both options are possible. Discharge avoids the high cost of a hospitalization, risk of a hospital-acquired infection, and delirium and permanent decline in the elderly. However, to safely discharge these patients a prompt follow-up appointment with the family physician (FP) must be ensured. Because the availability of follow-up care is often uncertain, many patients are simply admitted to hospital. THE PROBLEM: With the aging of the population, ED visits are going to accelerate. METHODS: Using Ontario databases, we have identified Ontarians seen in an Ontario ED with three common chronic diseases; we found that only half of those patients saw a doctor in the week after the emergency visit. We will determine whether lack of follow-up was associated with more deaths, return ED visits, hospitalizations, and taking recommended medications. IMPACT: The study will provide the first scientific evidence as to whether the current system of care between the ED and FP is adequate, and allow us to make informed decisions around future studies that aim to fix the problem.