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Variation in emergency department transfer rates from nursing homes in Ontario, Canada


Background — Nursing home (NH) residents are frequently transferred to the emergency department (ED) but there is little data on inter-facility variation, which has implications for intervention planning and implementation.

Objectives — To describe variation in ED transfer rates (TRs) across NHs and the association with NH characteristics.

Design/Setting — Retrospective cohort study using linked administrative data from Ontario.

Participants — 71,780 residents of 604 NHs in 2010 and followed for one year.

Measurements — Funnel plots were used to identify high transfer NHs and logistic regression to test the association with NH location, size, ownership and historical ED transfer rate.

Results — One-year ED transfer rates ranged from 4.3% to 58.6% (mean 28.4%); 115 (19%) NHs were considered high. Being within five minutes of an ED, larger size and high historical ED transfer rate were associated with being a high ED transfer home.

Conclusion — There was substantial variation across NHs. Consideration of characteristics such as proximity to an ED may be important in the development and targeting of different interventions for NHs.



Gruneir A, Bronskill SE, Newman A, Bell CM, Gozdyra P, Anderson GM, Rochon PA. Healthc Policy. 2016;12(2):76-88.

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