Original article
Vol. 145 No. 2122 (2015)
Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002–2012
- Maya Shaha
- Selina Gmuer
- Andreas W. Schoenenberger
- Fabienne Sarah Gerber
- Aristomenis K. Exadaktylos
Summary
BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria.
METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years).
RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson’s χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson’s χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years.
CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).
References
- Owens PL, Barrett ML, Gibson TB, Andrews RM, Weinick RM, Mutter RL. Emergency department care in the United States: a profile of national data sources. Ann Emerg Med. 2010;56(2):150–65.
- Li G, Lau JT, McCarthy ML, Schull MJ, Vermeulen M, Kelen GD. Emergency department utilization in the United States and Ontario, Canada. Acad Emerg Med. 2007;14(6):582–4.
- Biber R, Bail HJ, Sieber C, Weis P, Christ M, Singler K. Correlation between age, emergency department length of stay and hospital admission rate in emergency department patients aged >/=70 years. Gerontol. 2013;59(1):17–22.
- Pines JM, Mullins PM, Cooper JK, Feng LB, Roth KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc. 2013;61(1):12–7.
- Baumann MR, Strout TD. Triage of geriatric patients in the emergency department: validity and survival with the Emergency Severity Index. Ann Emerg Med. 2007;49(2):234–40.
- Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg Med. 2010;56(3):261–9.
- Businger A, et al. Demographic changes and their implications in a nonacademic emergency department in Switzerland: an 11–year trend analysis (2000–2010) of 104,510 patients International Scholarly Research Network, ISRN Emergency Medicine. 2012. 2012.
- Vilpert S, Ruedin HJ, Trueb L, Monod-Zorzi S, Yersin B, Büla C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital. BMC Health Serv Res. 2013;13:344.
- McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002;57(9):M569–77.
- Hastings SN, Heflin MT. A systematic review of interventions to improve outcomes for elders discharged from the emergency department. Acad Emerg Med. 2005;12(10):978–86.
- Shanley C, Sutherland S, Stott K, Tumeth R, Whitmore E. Increasing the profile of the care of the older person in the ED: a contemporary nursing challenge. Int Emerg Nurs. 2008;16(3):152–8.
- Institute of Medicine (U.S.). Committee on the Future of Emergency Care in the United States Health System., Hospital-based emergency care: at the breaking point. Future of emergency care. 2007, Washington, D.C.: National Academies Press. xxiii, 397 p.
- Institute of Medicine (U.S.). Committee on the Future of Emergency Care in the United States Health System., Emergency medical services at the crossroads. Future of emergency care. 2007, Washington, D.C.: National Academies Press. xxii, 285 p.
- Albert M, McCaig LF, Ashman JJ. Emergency department visits by persons aged 65 and over: United States, 2009–2010. NCHS Data Brief. 2013(130):1–8.
- Berger E. Bad report card. Ann Emerg Med. 2014;63(3):11A-12A.
- Wargon M, Guidet B, Hoang TD, Hejblum G. A systematic review of models for forecasting the number of emergency department visits. Emerg Med J. 2009;26(6):395–9.
- Schweigler LM, Desmond JS, McCarthy ML, Bukowski KJ, Ionides EL, Younger JG. Forecasting models of emergency department crowding. Acad Emerg Med. 2009;16(4):301–8.
- Universitäres Notfallzentrum. Universitäres Notfallzentrum 2011 [cited 2014 June,]; Webpage]. Available from: http://www.notfallzentrum.insel.ch/de/information-fuer-patienten/triage/. German.
- Marcilio I, Hajat S, Gouveia N. Forecasting daily emergency department visits using calendar variables and ambient temperature readings. Acad Emerg Med. 2013;20(8):769–77.
- Kessler C, Kutka BM, Badillo C. Consultation in the emergency department: a qualitative analysis and review. J Emerg Med. 2012;42(6):704–11.
- Finanzverwaltung des Kantons Bern. Bevölkerungsbewegung. 2014 [cited 2014 June]; Available from: http://www.fin.be.ch/fin/de/index/finanzen/finanzen/statistik/bevoelk/bevoelkerungsbewegung.html. German.
- Kantonale Fachstellung für die Gleichstellung von Frauen und Männern, gleich&anders. Zahlen zur Gleichstellung von Frauen und Männern im Kanton Bern Staatskanzlei Bern, Editor. 2011, Kantonale Fachstellung für die Gleichstellung von Frauen und Männern,: Bern. p. 1–56. German.
- Universitäres Notfallzentrum, Zusammenstellung der ICD-Diagnosen von 2014, Universitäres Notfallzentrum, Editor. 2015, Inselspital, Bern University Hospital: Bern. German.
- Schoenenberger AW, Bieri C, Özgüler O, Moser A, Haberkern M, Zimmermann H, et al. A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. Am J Emerg Med. 2014;32(6):623–8.
- Graf CE, Giannelli SV, Herrmann FR, Sarasin FP, Michel JP, Zekry D, et al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department – comparison of two screening tools. Swiss Med Wkly. 2012;141: p. w13327.