Emergency Department Visits, Hospital Admissions, and Wait Times for Patients With Urologic Conditions

Increased use of the emergency department (ED) creates strain on the single-payer public health care system in Canada.

To evaluate trends in ED visits and hospital admission rates for urologic conditions in Ontario, Canada, and to determine trends and associated factors for wait times to see a urologist among patients presenting to the ED.

This population-based, retrospective cohort study used health administrative data from all EDs and acute care hospitals in Ontario for all adult patients presenting to the ED with a primary urological diagnosis between January 1, 2007, and December 31, 2022. Analyses were performed from January 2023 to April 2024.

The main outcome was the rate of ED visits with new urologic diagnoses over time. Crude, age-standardized, and sex-standardized annual rates were estimated for index ED visits and hospital admissions. Wait times to see a urologist after ED visit were also determined.

A total of 2 192 213 unique visits to the ED with a main diagnosis of a urologic disorder were identified (mean [SD] patient age, 52.1 [21.2] years; 66.5% female). Of these, 1 732 356 visits represented a new urologic diagnosis (no visits in the prior 2 years). Age- and sex-standardized ED visit rates rose annually from 2007 (0.91 visits per 100 people) to 2015 (1.0 visits per 100 people) (rate ratio [RR], 1.10; 95% CI, 1.09-1.11), then decreased until 2020 (RR, 0.88; 95% CI, 0.87-0.88), before rising again until 2022 (RR, 0.91; 95% CI, 0.90-0.91). Among people seen in the ED with a urologic diagnosis, 10.0% were admitted to the hospital during the study period. The crude rate of admission rose annually (RR, 1.04; 95% CI, 1.03-1.05; P < .001), from 0.07 (95% CI, 0.07-0.08) admissions per 100 people in 2007 to 0.09 (95% CI, 0.09-0.09) in 2022. Patients with greater continuity of outpatient care had lower odds of being admitted. The mean (SD) wait time to see a urologist after an ED visit increased from 62.5 (80.3) days in 2007 to 84.8 (89.3) days in 2014. It subsequently decreased annually until 2022, to 71.1 (70.6) days. Increased comorbidity was associated with lower risk of outpatient urology visit.

In this cohort study, the annual ED visit rates for new urologic diagnoses, hospital admissions, and wait times to see urologists significantly increased over the study period. These trends were associated with decreasing continuity of care. This increasing burden of acute urologic disease necessitates investment in health care.