Children make more than one million visits a year to Ontario emergency departments: CIHI

ED visits more likely among the very young and on evenings, weekends; 1 in 15 children leave before the end of their visit

April 24, 2008 – In 2005-2006, 1 in 4 emergency department visits in Ontario were made by children (newborn to 17 years). This represents more than one million visits made by about 685,000 children, according to a new analysis by the Canadian Institute for Health Information (CIHI). The analysis found that nearly 1 in 3 of these children visited the emergency department (ED) more than once in the year, and 1 in 15-or more than 51,000 children-returned to the emergency department within 72 hours of their previous visit. The analysis, Children and Emergency Departments in Ontario, is CIHI’s first to examine when children come to emergency departments, how long they wait and what happens at the end of their visit.

“Making a trip to an emergency room with a sick or injured child can be a stressful experience for a young family. But it is also a common experience for Canadian families,” says Heather Dawson, Manager of Health Services Research at CIHI. “In Canada, Ontario has played a leading role in the collection of emergency department information. By understanding how and when children are using emergency departments, those managing the health system in Ontario can now better plan how to meet the health needs of children.”

Children younger than 5 most likely to visit EDs

By age group, children between the ages of 1 and 4 had the highest number of visits to Ontario emergency departments, making more than 323,000 emergency department visits in 2005–2006. This represents more than 1 visit for every 2 children between the ages of 1 and 4 in Ontario (or 596 visits per 1,000 population). In comparison, the overall average rate of emergency department visits for all children younger than age 18 was 386 per 1,000 population younger than 18, or 1 visit for every 3 children.

Newborns and babies younger than age one had the highest rate of emergency department visits, with 802 visits per 1,000 infants. Infants were also more likely to visit the emergency department more than once in the year, with 43% of these patients making repeat visits.

“Health planners can use this information as a starting point to examine what health services are available outside of the hospital setting in their area,” says Marilyn Booth, Executive Director of the Provincial Council for Children’s Health. “There may be opportunities to help new parents, particularly first-time parents, to identify and understand common medical conditions they are likely to encounter in the first year of their child’s life.”

Visits more likely on weeknights, Sundays

Regardless of age group, children were more likely to arrive at the emergency department in the evening. The most common time of day for children to visit the emergency department was between 7 p.m. and 8 p.m., and the most common day of the week for visits was Sunday.

In comparison, adults and seniors were more likely to visit Ontario emergency departments on Mondays, with arrivals peaking between 10 a.m. and 11 a.m.

Half of all children complete visit in less than two hours, but 1 in 15 leave before end of visit

Overall, wait times for children in Ontario emergency departments were slightly shorter than for adults in 2005–2006, with half of all children completing their emergency department visits in less than two hours. However, some children experienced longer waits. For example, while 1 in 10 completed their visit in 35 minutes or less, 1 in 10 children spent five hours or more from arrival to visit completion, and nearly 50,000 children left before their visit was complete. Of these children, 13% returned to the emergency department within 72 hours.

Wait times vary by hospital type and by region

Emergency department wait times also varied significantly by Ontario health region, or local health integration network (LHIN), in 2005–2006. Children experienced the longest median waits to see an emergency department physician in Waterloo Wellington (1.5 hours), Toronto Central and Champlain (1.2 hours each), while the South East LHIN had the shortest median wait time (0.6 hours).

CIHI’s analysis found that both median waits to see a physician and the total time children spent in Ontario emergency departments were longer on average in pediatric academic health sciences centres (PAHSCs, teaching hospitals that treat children in their emergency departments). However, the vast majority of children’s emergency department visits (82%) occurred in general hospitals.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

About CIHI’s National Ambulatory Care Reporting System

The National Ambulatory Care Reporting System (NACRS) includes data for all hospital-based and community-based ambulatory care, including emergency departments, day surgery and outpatient clinics. The province of Ontario is taking a leadership role in the collection on a province-wide basis of this information, which is used by policy-makers, researchers and ambulatory care providers to support the study of clinical outcomes and health status of Canadians. The goal of NACRS is to assist with the evaluation of the management of ambulatory care services in Canadian health care facilities and to facilitate provincial and national comparative reporting.