Healthcare Areas

Continuing care home residents are sometimes taken to the emergency department to address urgent healthcare needs. In many cases, an emergency department visit is necessary and the best course of action for a resident (e.g., a resident has a serious fall and a fracture is suspected).

However, some emergency department visits are unnecessary and avoidable. Using the emergency department appropriately is important for residents in continuing care, because transfers to emergency department place can result in poor health outcomes and decline (Hustey, 2010). Appropriate use of the emergency department also reduces costs to the healthcare system (Boockvar et al., 2008, Terrell and Miller, 2006).

The results for this measure cannot clearly be seen as better or worse because use of the emergency department, in some cases, is appropriate. Regardless, keeping use of the emergency department to those instances when the emergency department is the appropriate place for the care that is needed, is desirable.

This chart shows the volume of visits by continuing care home residents to the emergency department, by reporting the number of emergency department visits divided by 1,000 resident days. Resident days are the number of days a resident lived in continuing care. For example, if someone lived in continuing care home – type A (formerly long term care) for a full year, this would be 365 resident days. This could also be explained a different way, using the example that a 100-space site has 1,000 resident days every 10 days (100 spaces occupied x 10 days = 1,000 resident days). This calculation allows for comparisons between sites with different numbers of spaces and occupancy rates.

When thinking about the frequency of emergency department visits for continuing care home residents, providers and leaders can consider a number of things to better understand and improve these results. Some questions they could ask before taking action include:

• What are some of the common reasons continuing care home residents are going to the emergency department? Which of these reasons does a site have control over?
• How might a site manage conditions differently to avoid unnecessary emergency department visits?
• What changes across other areas of the healthcare system (outside of continuing care and emergency departments) could help to improve these results? For example, how might changes to community paramedicine or primary healthcare impact these results? What about the increased availability of mobile healthcare services (e.g., mobile x-rays)?
• How does the use of the emergency department vary across urban and rural areas? How is an “appropriate” emergency department visit defined differently between rural and urban areas?
• How might strengthening the relationship between the primary healthcare and continuing care sectors impact results?
• How might the different care models (e.g., continuing care homes – type B (formerly called designated supportive living) does not have a defined physician model) impact these results? How does the complexity and unpredictability of residents’ healthcare needs impact the results? What other factors might contribute to the variation that is seen in the results?

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality: Acceptability, Accessibility, Appropriateness, Effectiveness, Efficiency, and Safety.

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