title: Predictors of Low-Acuity Emergency Department Use by Patients Enrolled in a Family Health Team.
abstract: BACKGROUND
  The primary aim of this study was to determine the characteristics and develop a predictive model describing low acuity users of the emergency department (ED) by patients followed by a family health team (FHT). The secondary aim was to contrast this information with characteristics of high acuity users. We also sought to determine what factors were predictive of leaving without being seen (LWBS).
  
  
  METHODS
  This retrospective descriptive correlational study explored characteristics and factors predictive of low acuity ED utilization. The sample included all FHT patients with ED visits in 2011. The last ED record was chosen for review. Sex, age, Canadian Triage and Acuity Scale (CTAS), presenting complaint(s), time of day, day of week, number of visits, and diagnosis were recorded.
  
  
  RESULTS
  Of 1580 patients who visited the ED in 2011, 56% were CTAS 1-3 visits, 24% CTAS 4-5 and 20% had no CTAS recorded. Patients who were older than age 65 were approximately half as likely to have a CTAS level of 4-5 compared to younger patients (OR=0.605, CI=0.441,0.829). Patients older than age 65 were 1.75 times more likely to be CTAS level 1-2 (OR=1.745, CI=1.277, 2.383). Patients who went to the ED during the day were less likely to LWBS compared to night visits (OR=0.697, CI=0.532, 0.912). Interpretation Most low acuity ED utilization is by patients under the age of 65, while high acuity ED utilization is more common among patients older than age 65. Patients are more likely to LWBS during late evening and overnight periods (9 pm-7 am).
authors.affiliation: *Department of Family Medicine,McMaster University,Hamilton,Ontario,Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Jones
authors.affiliation: †The Centre for Family Medicine FHT,Kitchener,Ontario,Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jones
authors.affiliation: ‡Population Cancer Research Program,Department of Pediatrics,Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Kristen
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: §Department of Family Medicine,Western University,London,Ontario,Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee-Poy
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005192:Family Health / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D014218:Triage / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: CTAS 4; CTAS 5; ED Utilization; Emergency Department; Family Health Team; Low Acuity; Triage