Learning How to Keep Patients out of the ER

Today’s health-care costs make up nearly half of Ontario’s budget. With the proportion of seniors in our population growing fast, the costs of delivering health care continue to grow.

“Making health care more effective and more efficient is absolutely critical as the Ontario population ages,” says Women’s College Research Institute scientist Dr. Andrea Gruneir.

To move our system in the right direction, Dr. Gruneir led a study published recently in the peer-reviewed Journal of the American Medical Directors Association (JAMDA)(1). Her insights are helping policy-makers understand how gaps in the health-care system can increase the burden on emergency departments.

“By understanding how these gaps contribute to patterns of emergency department use, and possibly hospital readmission, we can begin to target new models of care that address these weak points in our system, and prevent health crises that lead to poor outcomes for patients. Especially frail older adults.”

Dr. Gruneir’s population-based cohort study examines rates of emergency department use by long-term care home residents. She linked health-care transitions, especially from hospital to long-term care, with an increase in emergency department transfers.

“The findings really highlight the need for a stronger focus on transitional care, especially for vulnerable older people who are being discharged from hospital to long-term care, and who often need more support to continue to get better,” says Dr. Gruneir.

Older women living in the community are more likely to rely on children for support, compared to older men who are more frequently cared for by their living spouse, according to another report(2) by Dr. Gruneir, released in November 2011.

“Most older people are women, and most are living with multiple chronic conditions,” Dr. Gruneir explains. “Also, most of these women are living without the benefit of a spouse’s care and support.”

With more supportive transitional systems, Dr. Gruneir hopes that vulnerable older people will be healthier and better supported. And so will their spouses as well as busy “sandwich generation” children.

“To develop effective new models that address these gaps and shortfalls in our health-care system, we need to understand where the weaknesses lie,” says Dr. Gruneir. “That’s what my work is focused on.”


Dr. Andrea Gruneir
Women’s College Research Institute


Toronto Central LHIN 2010 – 2013 Integrated Health Service Plan

Key priority:
“Reduce emergency room wait times and alternate level of care days.”

“Long emergency room wait times are a symptom of problems in the health system. One problem in particular is that many hospital in-patient beds are occupied by “alternate level of care” (ALC) patients waiting to be transferred to a more appropriate setting such as long-term care or home care.”

1 Gruneir A, Bronskill S, Bell CM, Gill SS, Schull M, Ma X, Anderson GM, Rochon PA. Recent Health Care Transitions and Emergency Department Use by Chronic Long-Term Care Residents: A Population-Based Cohort Study. JAMDA, 2011 Nov 7 [Epub ahead of print].

2 Bronskill SE, Corbett L, Gruneir A, Stevenson JE. Introduction. In: Bronskill Se, Camacho X, Gruneir A, Ho MM, editors. Health System Use by Frail Ontario Seniors: An in-depth examination of four vulnerable cohorts. Toronto, ON: Institute for Clinical Evaluative Sciences; 2011.