Strum Ryan P, Costa Andrew P, McLeod Brent, Sivakumaran Ravi, Mondoux Shawn
Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
J Health Serv Res Policy. 2025 Jul 9:13558196251358761. doi: 10.1177/13558196251358761.
BackgroundThere is a growing debate on whether avoidable emergency department (ED) visits, those involving health issues that could have been managed in community settings, represent a significant workload for the department. Until recently an ED physician-validated measure of avoidable visits has not been available, hindering our understanding of these patients, services rendered in the ED and the nature of their conditions. We examined patient characteristics of ED visits retrospectively classified as avoidable and potentially avoidable at a Canadian academic hospital.MethodsWe conducted a retrospective cohort study using administrative ED data from an academic hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023. We categorized all ED visits as avoidable, potentially avoidable, and not avoidable using the Emergency Department Avoidability Classification (EDAC). For each class, we analyzed patient characteristics and the top five physician interventions and diagnoses. We applied linear regression, locally weighted scatterplot smoothing (LOWESS) regression, and statistical process methods to examine monthly trends in avoidable and potentially avoidable visits. Additionally, we reported annual totals and length of stay for patients transported to the ED by paramedics.ResultsOverall, 58,528 (29.0%) of 201,741 ED visits were classified as either avoidable (11,302; 5.6%) or potentially avoidable (47,226; 23.4%). These patients were predominantly young-to-middle aged, with average visit durations of 3 hours 33 minutes (avoidable) and 4 hours 26 minutes (potentially avoidable). Their primary interventions were predominantly diagnostic imaging, skin repairs and mental health assessments. The proportion of ED visits in the study period that were avoidable increased from 2.1% to 7.7% and potentially avoidable from 18.2% to 21.2%. Approximately one-in-five paramedic transported patients were classified as having either an avoidable or potentially avoidable ED visit. Transported patients had an average length of stay of 4 hours 22 minutes for avoidable visits and 4 hours 35 minutes for potentially avoidable visits.ConclusionsA notable rise in the proportion of ED visits that could have been managed in non-ED settings was observed. Providing community clinicians with resources and capacity to manage and refer patients for diagnostic imaging, skin repairs and mental health assessments may reduce avoidable ED attendance. Further exploration of avoidable ED visits transported by paramedics could support refining ED diversion care models. Hospitals and health service policymakers could benefit from similar analyses using validated measures to identify care gaps that inform the development of new health services and models tailored to the specific needs of their communities.
背景
关于可避免的急诊科（ED）就诊，即那些涉及本可在社区环境中处理的健康问题的就诊，是否给该科室带来了大量工作量，争议日益增多。直到最近，一直没有经过急诊科医生验证的可避免就诊衡量标准，这阻碍了我们对这些患者、急诊科提供的服务及其病情性质的了解。我们回顾性研究了加拿大一家学术医院中被归类为可避免和潜在可避免的急诊科就诊患者的特征。
方法
我们使用了加拿大汉密尔顿一家学术医院2018年4月1日至2023年8月31日的急诊科管理数据进行回顾性队列研究。我们使用急诊科可避免性分类（EDAC）将所有急诊科就诊分为可避免、潜在可避免和不可避免三类。对于每一类，我们分析了患者特征以及前五项医生干预措施和诊断。我们应用线性回归、局部加权散点图平滑（LOWESS）回归和统计过程方法来研究可避免和潜在可避免就诊的月度趋势。此外，我们报告了由护理人员送往急诊科的患者的年度总数和住院时间。
结果
总体而言，201,741次急诊科就诊中有58,528次（29.0%）被归类为可避免（11,302次；5.6%）或潜在可避免（47,226次；23.4%）。这些患者主要是中青年，可避免就诊的平均时长为3小时33分钟，潜在可避免就诊的平均时长为4小时26分钟。他们的主要干预措施主要是诊断性影像学检查、皮肤修复和心理健康评估。研究期间可避免的急诊科就诊比例从2.1%增至7.7%，潜在可避免的比例从18.2%增至21.2%。大约五分之一由护理人员运送的患者被归类为有可避免或潜在可避免的急诊科就诊。对于可避免就诊，运送患者的平均住院时间为4小时22分钟，对于潜在可避免就诊为4小时35分钟。
结论
我们观察到本可在非急诊科环境中处理的急诊科就诊比例显著上升。为社区临床医生提供管理和转诊患者进行诊断性影像学检查、皮肤修复和心理健康评估的资源和能力，可能会减少可避免的急诊科就诊。进一步探索由护理人员运送的可避免急诊科就诊情况，可能有助于完善急诊科分流护理模式。医院和卫生服务政策制定者可通过使用经过验证的衡量标准进行类似分析来受益，以识别护理差距，为开发满足其社区特定需求的新卫生服务和模式提供信息。
