ED visits

Issue: Ontario (and Canada) have high ED visit rates.  A large part of the rationale for investment in primary care, and primary care teams in particular, is to reduce ED visits.  In addition, the MOHLTC has signalled an intent to include ED visits as an indicator to monitor primary care performance in the future. There are several approaches to tracking unnecessary Emergency Department visits including “ED visits Best Managed Elsewhere”, “less urgent ED visits – CTAS 4-5” and patient self-report of ED visits.  For various reasons, none of these definitions are believed to generate a useful estimate of the number of patients for whom primary care providers could provide an alternative to ED care. Clinicians will receive information about the relative advantages and limitations of various definitions and the related challenges in accessing data. Questions for clinical input 1)      What are the key characteristics of “unnecessary” ED visits? 2)      Do we really need a different measure than “triage score 4 or 5”?