Impact of Health Link utilization on emergency department visits.

Objectives: Our aim was to compare Health Link utilization in urban and rural Alberta by metrics relevant to the ED.

Methods: Data on Health Link callers from January 1, 2018-December 31, 2019 was extracted from the National Ambulatory Care Reporting System, including postal code, location of ED attended, Canadian Triage Acuity Scale (CTAS) assigned at ED, age, and self-identified gender. Usage density (presentations/100/year), patient demographics (age, self-identified gender), and ED metrics (CTAS, investigations, admission) were compared for Health Link ED referrals and direct ED visits.

Results: In this period, 900,196 individuals called Health Link, 241,103 were referred to the ED, 58% (140,614) of which presented to the ED within 24 h of their call. These referrals constituted 3.4% of the total ED visit population (4,194,735). Looking at the density of ED utilization, this is greater in rural than urban settings with respect to patients who present directly to the ED (90.9 vs. 36.5 presentations/100/year). There is a sparser density of Health Link ED visits in rural settings than in urban centres (1.5 vs. 1.6). Urban ED presentations were more often triaged as a CTAS 1-3 than a CTAS 4-5 if they had presented after a Health Link referral (76.0% CTAS 1-3) than a direct ED visit (63.0% CTAS 1-3). This effect is greater for rural patients, who also more likely to present as a CTAS 1-3 than a CTAS 4-5 if they were referred through Health Link (61.1% CTAS 1-3) compared to those who directly went to the ED (39.0% CTAS 1-3).

Conclusions: This study on Health Link describes how tele-health can often triage higher acuity patients to appropriately receive ED level care, which may be important for future development of health care and ED infrastructure.