MP04: Predicting future ED needs – population trends may not be enough!

Abstract

Introduction: As the population of Canadian cities grows, public policy planners frequently base predictions of future demand on population trends. We aimed to discover the relationship between demographically defined ED visit rate (EDVR) trends in an academic ED with corresponding population trends in the catchment area. Methods: We used administrative data to conduct a retrospective cohort time series to analyze per capita EDVR trends based on CTAS, age, gender and housing status for the period 2006-2015. These were adjusted for population growth using age-gender standardized rates from 2011 census data. All EDVR and Standardized estimates were extrapolated for 100,000 population. Results: There were 646 731 visits during the study period, increasing by 25.6% from 56 757 in 2006 to 71 289 in 2015, with an annual incremental linear trend of 1893/year (CI:1593-2192). The highest CTAS2 EDVR increase, 521/year, (95%CI: 433-608) was by non-homeless patients older than 49. CTAS2 visits and the rate in all non-homeless patients increased by 335/year, (95% CI 280-391), while homeless patients less than 30 showed the highest CTAS2 EDVR annual rate incremease (1183/year, CI:1448-2218). From 2008-2015, the annual linear per capita CTAS5 EDVR declined by 121/year (CI:79-163). The population of adults in Halifax increased by1.2%/yr with a linear trend of 4149/year (CI:4012-4287). The highest linear increasing trend was for those older than 49 (2604/year CI:2494-2714), followed by 30-50-year old group (1223/year, CI:1138-1309) with the lowest trend for those aged less than 30 (322/year,CI:170-473). Standardized and non-standardized rate decline (CTAS5) and incline (CTAS2) were statistically similar and were not influenced by population changes. The population older than 49 increased by 38% over the 10 year period, whereas the CTAS2 visit change increased by 250%. If the CTAS2 EDVR trend continues, this rate in 2027 will double that of 2015, even if the population in the catchment area remains stable. Conclusion: EDVR trends show an increase in CTAS2 visits driven chiefly by older patients. This trend exceeds the trend suggested by Canadian Foundation for Healthcare Improvement and is significantly more than predicted by population demographic changes. Healthcare administrators will need to bear these disparities in mind as they prepare for future ED capabilities.