Hospital characteristics and emergency department care of older patients are associated with return visits.
OBJECTIVE
To explore hospital characteristics and indicators of emergency department (ED) care of older patients associated with return visits to the ED.


METHODS
Provincial databases in the province of Quebec, Canada, and a survey of ED geriatric services were linked at the individual and hospital level, respectively. All general acute care adult hospitals with at least 100 eligible patients who visited an ED during 2001 were included (N = 80). The study population (N = 140,379) comprised community-dwelling individuals aged 65 years and older who made an initial ED visit in 2001 and were discharged home. Characteristics of the hospitals included location, number of ED beds, ED resources, and geriatric services in the hospital and the ED. Indicators of ED care at the initial visit included day of the visit, availability of hospital beds, and relative crowding. The main outcome was time to first return ED visit; the authors also analyzed the type of return visit (with or without hospital admission at return visit, and return visits within seven days).


RESULTS
In multilevel multivariate analyses adjusting for patient characteristics (sociodemographic, ED diagnosis, comorbidity, prior health services utilization), the following variables were independently associated (p < 0.05) with a shorter time to first return ED visit: more limited ED resources, fewer than 12 ED beds, no geriatric unit, no social worker in the ED, fewer available hospital beds at the time of the ED visit, and an ED visit on a weekend.


CONCLUSIONS
In general, more limited ED resources and indicators of ED care (weekend visits, fewer available hospital beds) are associated with return ED visits in seniors, although the magnitude of the effects is generally small.
McCusker
Jane
J
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada. jane.mccusker@mcgill.ca
Ionescu-Ittu
Raluca
R
Ciampi
Antonio
A
Vadeboncoeur
Alain
A
Roberge
Danièle
D
Larouche
Danielle
D
Verdon
Josée
J
Pineault
Raynald
R
D000368:Aged; D000369:Aged, 80 and over; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D017050:Episode of Care; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D011792:Quebec