Grant: Planning and Dissemination Grant - Institute Community Support

Each year 12 million people visit an emergency department (ED) in Canada, with the highest rates among the elderly. Some will be admitted to hospital, but most are discharged directly 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, the risk of a hospital-acquired infection, and of delirium in the elderly. However, in order to safely discharge these patients home from the ED, a system of care must be in place to ensure a prompt follow-up appointment with the primary care provider (PCP) or specialist. Our research on older ED patients with atrial fibrillation found that these patients had a 127% increased risk of death if they had no follow-up care after the ED visit. Because the system for ensuring follow-up care is often unreliable, many patients are simply admitted to hospital. With the aging of the population, ED visits by patients with chronic diseases are expected to increase dramatically in the near future. Admitting the same percentage of patients will not be feasible for the current health care system, nor is it beneficial for many patients, if they can obtain the same care in the community. Currently, however, there is no way of knowing if they will get that care when the ED decision to either admit the patient, or to discharge them home, is made. The proposed meeting will bring together a multi-disciplinary team of provincial and local policy-makers, government officials, hospital administrators, researchers, physicians, IT experts, and other stakeholders, to bring their expertise to bear on how to ensure continuity of care between the ED and the PCP, for all Ontarians, and subsequently Canadians, who suffer from serious chronic diseases. The June 18 meeting will assess new ideas, key barriers to implementation, and potential solutions. The best solutions will be pilot-tested by the research team in a future trial.