ICES | Emergency Department Services in Ontario 1993 - 2000 - page 6

The Use of ED Services by Patients
How often do people visit the ED?
In 2000, there were 3.7 million ED visits in Ontario. Of the approximately
11.5 million people in Ontario, 2.25 million individuals, or almost one-fifth of
the population, made at least one visit to an ED. Most patients who visited
EDs did so only occasionally. Two-thirds of ED patients visited the ED only
once during the year. Only 6.6 per cent of ED patients visited an ED four or
more times in a year.
Young children and the elderly had the highest rates of ED use. Thirty-four per
cent of children under five years of age visited an ED at least once, as did 29
per cent of the population 75 and older, compared to 18 per cent for persons
5 to 74 years of age. The number of visits per person also varied by age,
again with young children and the elderly having the highest number of visits
(Exhibit 2).
Although the elderly had high rates of use, they accounted for a relatively
small proportion of total ED visits, because they represent a relatively small
part of the population. Adults aged 20 to 64 made up 52.4 per cent of all ED
visits, compared to 31.0 per cent for individuals under age 20 and 16.5 per
cent for those aged 65 and over.
How has the use of EDs changed over time?
Per capita ED use declined by 10.3 per cent during the study period (Exhibit 3),
with most of the decline occurring around the middle of the decade (1995
to 1997). Per capita ED use rose for the elderly during the study period and
declined for the pediatric and young adult population (Exhibit 2). This
corresponded with a rise in the average age of the ED visitor, from 32.4 years
in 1993 to 36.5 in 2000. The average age of Ontarians was 35.1 in 1993 and
36.4 in 2000.
The substantial decline in per capita ED use during the study period was
accompanied by an 8.9 per cent increase in the population. The total number
of ED visits in Ontario declined by 2.2 per cent. However, with the closure of
20 EDs, the average number of patients seen at an ED per year rose by 9.7
per cent, from 19,100 to 21,000.
When do peaks and dips in ED volume occur?
The ED system as a whole experienced large fluctuations in daily volume
throughout the course of the each study year. On the busiest day of 2000, the
total ED visit volume was 56 per cent above the average daily volume for
that year. The lightest day was 25 per cent below average.
Some of this variation was predictable. ED use varied by the day of the
week, with the heaviest volume of visits occurring on Sunday, then Saturday
and Monday (Exhibit 4). ED use also varied by the time of the year (Exhibit 5).
Utilization was higher in the winter and summer months, and characteristic
peaks coincided with public holidays. The week straddling the Christmas
holiday was the busiest in the year in terms of ED visit volume. Exhibit 6
identifies some typically busy days during the year.
How often do patients visit the ED in the middle of the night?
Exhibit 7 lists the proportion of ED visits which occur between midnight and
morning hours (7 or 8 am—see Exhibit T1 in the Technical Appendix). Urban
EDs had a substantially higher proportion of their caseload occurring after
midnight compared to rural EDs (rural EDs being those eligible for the Scott
sessional fee for rural hospitals). The proportion of ED visits occurring after
midnight in urban EDs rose during the study period.
What types of medical conditions are managed in the ED?
Exhibit 8 lists the discharge diagnoses of patients visiting the ED and compares
them to those reported in EDs in the United States (U.S.) in 1999. Diagnoses
are quite similar overall, and small differences may reflect variations in coding.
In both Ontario and the U.S., the top three reasons for visiting an ED are the
same: trauma (major and minor), general signs and symptoms, and respiratory
Discharge diagnoses varied by patient age and sex category (Exhibit 9).
Trauma (major and minor) was common in all ages, but more common in
pediatric and middle-aged males. In the pediatric age group, the most
common diagnoses were colds, ear infections and other infectious diseases.
Young and middle-aged men and women were diagnosed more often than
other age groups with psychological and social disorders. Among the elderly,
cardiovascular disease and chest pain not yet diagnosed were common.
Other categories representing signs and symptoms not yet diagnosed were
also more common in the elderly.
There was a modest decline in the proportion of all patients with colds, ear
infections and other infectious diseases, from 19.2 per cent in 1993 to 17.8
per cent in 2000.
Institute for Clinical Evaluative Sciences
Emergency Department Services in Ontario
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