The impact of person-centred care on job productivity, job satisfaction and organisational commitment among employees in long-term care facilities.

AIM AND OBJECTIVES: This study aimed to explore the effects of person-centred care on their job productivity, job satisfaction and organisational commitment among employees in long-term care facilities. BACKGROUND: Person-centred care has been regarded as the best caregiving model for long-term care facilities. Few studies tested the impact of person-centred care on employee performance. DESIGN: A cross-sectional study was employed. METHODS: This study sent 373 samples with self-report questionnaires to the employees of sixteen long-term care facilities in Taiwan. A total of 366 valid samples were collected. A 33-item person-centred care questionnaire with Likert-scale responses was developed to assess the extent of person-centred care. We adopted hierarchical multiple regression analysis to test the impact of person-centred care on employee performance. We adopted the STROBE guidelines. RESULTS: Friendly environment level and personalised care, respectively, scored the highest with a mean of 4.19 among five dimensions of person-centred care. Personalised care, residents' self-realisation and relationships, and organisational support had significant positive correlations with job productivity. Friendly environment level and organisational support had significant correlations with job satisfaction. Friendly environment level, residents' self-realisation and relationships, and organisational support had significant correlations with organisational commitment. CONCLUSION: Person-centred care has beneficial impact on job satisfaction, job productivity and organisational commitment of employees in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Person-centred care appears to be a crucial factor of employee performance in long-term care facilities. The five-dimensional person-centred care questionnaire in this study can serve as an important management tool for improving the effectiveness of person-centred care.

Developing and testing the patient-centred innovation questionnaire for hospital nurses.

AIMS: Develop the patient-centred innovation questionnaire for hospital nurses and establish its validity and reliability. BACKGROUND: Patient-centred care has been adopted by health care managers in their efforts to improve health care quality. It is regarded as a core concept for developing innovation. METHODS: A cross-sectional study was employed to collect data from hospital nurses in Taiwan. This study was divided into two stages: pilot study and main study. In the main study, 596 valid responses were collected. This study adopted reliability analysis, exploratory factor analysis, confirmatory factor analysis and selected nurse innovation scale as a criterion to test criterion-related validity. RESULTS: Five-dimension patient-centred innovation questionnaire was proposed: access and practicability, co-ordination and communication, sharing power and responsibility, care continuity, family and person focus. Each dimension demonstrated a reliability of 0.89-0.98. All dimensions had acceptable convergent and discriminate validity. The patient-centred innovation questionnaire and nurse innovation scale exhibited a significantly positive correlation. CONCLUSIONS: Patient-centred innovation questionnaire not only had a good theoretical basis but also had sufficient reliability and construct validity, and criterion-related validity. IMPLICATIONS FOR NURSING MANAGEMENT: Patient-centred innovation questionnaire could give a measure for evaluating the implementation of patient-centred care and could be used as a management tool during the process of nurse innovation.

Can nurse innovation improve customer perception of service quality and experience?

AIMS AND OBJECTIVES: This study aimed to clarify how nurse innovation is related to customer perception of medical service quality and experience. BACKGROUND: Recently, many hospitals have put much emphasis upon the development of nurse innovation. DESIGN: A cross-sectional study was employed. METHODS: This study adopted questionnaire survey method with nurses and customers of the inpatient wards from three Taiwanese hospitals as the research subjects. After pairing, there were 294 valid questionnaires. Hierarchical regression analysis was utilised to test the possible impact of nurse innovation on medical service quality and experience. RESULTS: In terms of the dimensions of nurse innovation, 'innovation behaviour' ranked the highest (3·24), followed by knowledge creation and innovation diffusion; in terms of the degree of the medical service quality, 'reliability' ranked the highest (4·35). As for the degree of the medical service experience, 'feel experience' ranked the highest (4·44). All dimensions of nurse innovation have no significant effects on medical service quality and experience. CONCLUSION: Of these three dimensions of nurse innovation, the level of innovation behaviour was perceived by the nurses as the highest. The study found that nurse innovation has no significant effects on customer perception of service quality and experience. RELEVANCE TO CLINICAL PRACTICE: Hospitals shall provide sufficient resources and budget for fostering innovation development and encourage their nurses to develop nursing innovation for patents. The education and training courses on 'patient-centred' shall be enhanced among hospital nurses. Healthcare managers shall also explore the difficulties about innovation diffusion and find the solutions for nurses.

The utilization of fluoride varnish and its determining factors among Taiwanese preschool children.

BACKGROUND: The Taiwanese government considers fluoride varnish to be a major component of preventive dental cares for preschool children. This study aimed to explore the extent of utilization of fluoride varnish and its determining factors among Taiwanese preschool children. METHODS: Using preschool children under the age of 5 years as our participants, this study was conducted based on the 2008 Taiwan database of the Ministry of the Interior, linked with information gathered between 2006 and 2008 on preventive healthcare and health insurance from the Bureau of Health Promotion and the National Health Research Institute. A total of 949,023 preschool children (< 5 years old) were identified to meet the requirement for fluoride varnish services. RESULTS: The percentage of Taiwanese preschool children that used fluoride varnish was 34.85%.The probability that fluoride varnish would be utilized was higher among children with catastrophic illness/injury or relevant chronic illnesses than those without. In addition, the probability of children with disabilities using fluoride varnish was lower than that of nondisabled children. Finally, parent sex, parent age, urbanization level of residence, and parents' premium-based salary significantly affected the children's utilization probability of fluoride varnish. CONCLUSION: In order to increase the utilization of fluoride varnish among preschool children in Taiwan in the future, target groups consisting of females, children < 3 years of age, and disabled children should be prioritized. Parental factors are also important in affecting the utilization of fluoride varnish in children.

Investigating the relationship among transformational leadership, interpersonal interaction and mentoring functions.

AIMS AND OBJECTIVES: This study aims to ascertain the relationship between transformational leadership, interpersonal interaction and mentoring functions among new staff nurses. BACKGROUND: Mentoring functions could improve the job performance of new nurses, provide them with support and thus reduce their turnover rate. DESIGN: A cross-sectional study was employed. METHODS: A questionnaire survey was carried out to collect data among a sample of new nurses from three hospitals in Taiwan. After gathering a total of 306 valid surveys, multiple regression analysis was applied to test the hypothesis. RESULTS: Inspirational motivation, idealised influence and individualised consideration had positive correlations with the overall mentoring function, but intellectual stimulation showed a positive association only with career development function. Perceived similarity and interaction frequency also had positive correlations with mentoring functions. When the shift overlap rate exceeded 80%, mentoring function showed a negative result. CONCLUSION: The transformational leadership of mentors would improve the mentoring functions among new staff nurses. Perceived similarity and interaction frequency between mentees and mentors also had positive correlations with mentoring functions. RELEVANCE TO CLINICAL PRACTICE: It is crucial for hospitals to redesign their leadership training and motivation programmes to enhance the transformational leadership of mentors. Furthermore, nursing managers should promote interaction between new staff nurses and their mentors; however, the shift overlap rate should not be too high.

The Impact of Market Orientation on Patient Safety Climate Among Hospital Nurses.

Improving market orientation and patient safety have become the key concerns of nursing management. For nurses, establishing a patient safety climate is the key to enhancing nursing quality. This study explores how market orientation affects the climate of patient safety among hospital nurses. We proposed adopting a cross-sectional research design and using questionnaires to collect responses from nurses working in two Taiwanese hospitals. Three-hundred and forty-three valid samples were obtained. Multiple regression and path analyses were conducted to test the study. Market orientation was defined as the combination of customer orientation, competitor orientation, and interfunctional coordination. Customer orientation directly affects the climate of patient safety. Although the findings only supported Hypothesis 1, competitor orientation and interfunctional coordination positively affected the patient safety climate through the mediating effects of hospital support for staff. Health care managers could encourage nurses to adopt customer-oriented perspectives to enhance their nursing care. In addition, to enhance competitor orientation, interfunctional coordination, and the patient safety climate, hospital managers could strengthen their support for staff members.

Exploring the impact of transformational leadership on nurse innovation behaviour: a cross-sectional study.

AIM: This study explored the influences of transformational leadership on nurse innovation behaviour and the mediating role of organisational climate. BACKGROUND: Recently, global nursing experts have been aggressively encouraging nurses to pursue innovation in nursing in order to improve nursing outcomes. Nursing innovation, in turn, is affected by nursing leadership. METHOD: We employed a questionnaire survey to collect data, and selected a sample of nurses from hospitals in Taiwan. A total of 439 valid surveys were obtained. Hierarchical multiple regression model analysis was conducted to test the study hypothesis. RESULT: The mean values of agreement of nurse innovation behaviour and transformational leadership were 3.40 and 3.78, respectively. Patient safety climate and innovation climate were found to have full mediating effects on the relationship between transformational leadership and innovation behaviour. CONCLUSION: Organisational climate has a significant impact on innovation behaviour. Transformational leadership has indirect effects on innovation behaviour via the mediation of patient safety climate and innovation climate. IMPLICATIONS FOR NURSING MANAGEMENT: Hospitals should enhance transformational leadership by designing leadership training programmes and establishing transformational culture. In addition, nursing managers should foster nursing innovation through improvements in organisational climate.

Exploring factors influencing residents' health outcomes in long-term care facilities: 1-year follow-up using latent growth curve model.

PURPOSE: This study explored the residents' health outcomes of long-term care (LTC) facilities and examined the risk factors in individual and institutional levels during 1 year of admission. METHODS: The study included four stages of interviews with residents in 31 nursing homes and 64 residential care homes. Three hundred and twenty-five residents at baseline were interviewed, and 206 completed the interviews at follow-up. Five outcomes including residents' physical/mental functional status and subjective health status in Short Form-36 were analyzed using latent growth curve models (LGCMs). RESULTS: Only the physical component summary (PCS) had increased significantly. The most influential risk factors to outcomes were the intra-individual-level time-varying variables, including self-rated health and with/without tubing care. Some predictive inter-individual-level factors were also found. For institutional characteristics, small-sized homes (<49 beds) with low occupancy rates showed a lower growth rate in residents' mental component summary (MCS) and PCS over 1 year and private sector homes showed the most significant growth rates in MCS. CONCLUSIONS: The methodological strength using LGCMs provides a framework for systematically assessing the influence of risk factors from various levels on residents' outcomes and follow-up change. It is evident that factors in various levels all influenced residents' outcomes which support critical information for case mix and quality management in LTC facilities. Under the scenario of a surplus of institutional care in Taiwan, we suggest that institutions must focus more on residents' psychological well-being and care quality, especially in small-sized homes in relation to the outcomes of its residents.

Perceptual market orientation gap and its impact on relationship quality and patient loyalty: the role of internal marketing.

The purpose of this study was to explore the perceptual market orientation gaps between physician and patients and its impact on relationship quality and patient loyalty, and to verify the critical role of internal marketing on developing market orientation. Self-administered questionnaires were then employed to collect the data. We used a convenience sample of physicians and patients at a medical center in central Taiwan, and 90 usable questionnaires from physicians and 450 usable questionnaires from patients were returned. Hierarchical multiple regression analyses were used to validate the research hypotheses. Physicians' perceptual market orientation had a positive influence on physician-patient relationship quality, hospital-patient relationship quality, and patient loyalty, but the perceptual market orientation gap between physicians and their patients had a direct negative impact on these constructs. Finally, internal marketing was found to have an influence on relationship quality and patient loyalty through the mediation of market orientation. In order to enhance relationship quality and patient loyalty, hospital managers should focus their efforts on improving employees' market orientation and reducing patients' perceptual market orientation gap. In addition, internal marketing was found to be a useful pathway in developing market orientation.

Exploring the cross-level impact of market orientation on nursing innovation in hospitals.

BACKGROUND: Recently, many hospitals have been enthusiastically encouraging nurses to pursue nursing innovation to improve health care quality and increase nursing productivity by proposing innovative training methods, products, services, care skills, and care methods. PURPOSES: This study tried to explore the cross-level impact of market orientation on nursing innovation. METHODOLOGY: In our study, 3 to 7 nurses and 1 manager were selected from each nursing team to act as respondents. The questionnaire survey began after the managers of each nursing team and the nurses had been anonymously coded and paired up in Taiwan in 2009-2010. A total of 808 valid questionnaires were collected, including 172 valid teams. Hierarchical linear modeling was used for the analysis. FINDINGS: Nursing innovation is the sum of knowledge creation, innovation behavior, and innovation diffusion displayed by the nurses during nursing care. The level of knowledge creation, as perceived by the nurses, was the highest, whereas the level of innovation diffusion was the lowest. Results of hierarchical linear modeling showed that only competitor orientation yielded a significant positive influence on knowledge creation, innovation behavior, or innovation diffusion. The r values were 0.53, 0.49, and 0.61, respectively. Customer orientation and interfunctional coordination did not have significant effects on nursing innovation. PRACTICE IMPLICATIONS: Hospital nurses exhibited better performance in knowledge creation than in innovation behavior and diffusion. Only competitor orientation had a significantly positive and cross-level influence on nursing innovation. However, competitor orientation was observed to be the lowest dimension of market orientation, which indicates that this factor should be the focus when improving nursing innovations in the future. Therefore, managers should continually understand the strategies, advantages, and methods of their competitors.

Factors influencing nurses' intentions toward the use of mobile electronic medical records.

The purpose of this study was to investigate the factors influencing nurses' intentions toward the use of mobile electronic medical records, based on the Theory of Diffusion of Innovations. The cross-sectional study used a structured questionnaire for data collection, focusing on the nurses of a large hospital in southern Taiwan. A total of 720 valid questionnaires were returned yielding a response rate of 82.0%. Multiple regression analysis of the responses identified three innovative characteristics, compatibility, complexity, and observability, as significantly influencing nurses' intentions toward adopting mobile electronic medical records, whereas relative advantage and trialability did not. In addition, nursing seniority affected nurses' intentions significantly toward adopting mobile electronic medical records. Implications of effects of the factors and future research directions are discussed.

The cross-level impact of patient safety climate on nursing innovation: a cross-sectional questionnaire survey.

AIMS AND OBJECTIVES: To explore the cross-level effects of the four dimensions of patient safety climate on nursing innovation. BACKGROUND: Across the globe, nursing innovation is highly encouraged by nursing experts to improve nursing outcome. Nursing innovation, in turn, is affected by organisational climate, and a critical aspect of organisational climate is patient safety. DESIGN: This is a cross-sectional study. METHODS: We employed a questionnaire survey to collect data and selected nurses from Taiwan hospitals as samples. A total of 808 valid questionnaires in 172 teams of four hospitals were collected. Patient safety climate was aggregated by individual-level data; thus, we examined r(wg) , ICC 1 and ICC 2. Hierarchical linear modelling was used to analyse the data. RESULTS: Of these three dimensions of nursing innovation, the level of knowledge creation was perceived by the nurses as the highest. In terms of patient safety climate, managerial practices regarding patient safety scored the highest, followed by patient safety procedures, patient safety information flow and patient safety priority. Only patient safety information flow yielded a significant positive influence on knowledge creation, innovation behaviour or innovation diffusion. CONCLUSION: Hospital nurses do achieve better performance in knowledge creation. Patient safety information flow has positive and cross-level impact on nursing innovation; therefore, the method to increase safety information flow is the key focus of nursing innovation management. RELEVANCE TO CLINICAL PRACTICE: Through the improvements made in patient safety climate, hospital managers could promote the development of nursing innovation. Patient safety information flow is positively associated with nursing innovation. Patient safety information could be integrated in nursing training in all levels. Rules and procedures regarding patient safety should be drafted in simple and clear terms. A procedure to review and revise the rules and procedures will also be helpful in improving patient safety information flow.

High incidence of hepatocellular carcinoma in ESRD patients: caused by high hepatitis rate or 'uremia'? a population-based study.

OBJECTIVE: A high incidence of hepatocellular carcinoma has been reported in end-stage renal disease patients. This study was undertaken to evaluate whether this was caused by a high rate hepatitis or 'uremia' per se. METHODS: We used claims data of the Bureau of National Health Insurance of Taiwan for analysis. All patients diagnosed with end-stage renal disease having received their first dialysis between 1 January 2003 and 31 December 2007 (n = 38 714) were enrolled for the study. A database of 1 million randomly selected subjects matched for age, gender, hepatitis B and C infection, and liver cirrhosis for the same period was used as control (n = 38 714). The longest observation period was up to 31 December 2008. RESULTS: There was no significant difference in the incidence of hepatocellular carcinoma between end-stage renal disease patients and their non-end-stage renal disease counterparts (2.03 per 1000 person-years vs. 2.10 per 1000 person-years, rate ratio = 0.947; 95% confidence interval: 0.792-1.132). End-stage renal disease patients with hepatocellular carcinoma had higher percentages of diabetes mellitus, hypertension, heart failure and gout (all P < 0.001), and they presented with a worse cumulative survival rate than the non-end-stage renal disease group (P < 0.001). End-stage renal disease patients developing hepatocellular carcinoma were younger, and had more comorbidities than their non-end-stage renal disease counterparts. End-stage renal disease (hazard ratio = 1.61) and diabetes mellitus (hazard ratio = 1.55) were found to be independent factors for mortality in hepatocellular carcinoma patients. CONCLUSIONS: After matching for hepatitis and liver cirrhosis, end-stage renal disease is not associated with a higher incidence of hepatocellular carcinoma than the general population. The high incidence of hepatocellular carcinoma in end-stage renal disease patients was caused by a high viral hepatitis rate rather than 'uremia' per se. Owing to increased comorbidity, end-stage renal disease patients developing hepatocellular carcinoma had worse long-term survival than non-end-stage renal disease patients.

The use of fluoride varnish and its determining factors among children with disability in Taiwan.

The oral health of children with disability is often not as good as that of other children. In view of improving their oral health, this study aims to explore the utilization of fluoride varnish services among children with disability in Taiwan and its relevant influencing factors. With children under the age of 5 as subjects, this study is conducted based on the database of Ministry of the Interior, Executive Yuan, ROC in 2008, coupled with information gathered between 2006 and 2008 on preventive health care and health insurance from the Bureau of Health Promotion and the National Health Research Institute, respectively. In addition to descriptive statistics and bivariate analysis, this study examined the factors determining the use of fluoride varnish with logistic regression analysis. Research revealed that fluoride varnish is used by up to 9.84% of children with disability; the use increases with age and decreases with increased level of disability, but is remarkably higher in those with catastrophic illness/injury. The probability of fluoride varnish use is lower among those living in areas of lower urbanization (levels 5-7) and higher among those whose parents have higher premium-based monthly salaries. Recommendations include (1) providing a differential pricing scheme for fluoride varnish based on the level of disability of the child, (2) promoting proactively among dentists to carry out regular fluoride varnish in rural areas and collaboration with pediatricians to provide convenient services and (3) targeting families in low socioeconomic brackets, improving knowledge of fluoride varnish.

Exploring the impact of customer relational benefit on relationship commitment in health service sectors.

BACKGROUND: An increasing number of health service sectors have begun to implement relationship marketing to try to establish long-term relationship with customers. PURPOSE: Customer relational benefit has been an important subject for relationship marketing researchers. This study was conducted to investigate how customer relational benefit might influence relationship commitment in health service sectors. METHODOLOGY: The research used a questionnaire survey that retrieved a total number of 403 valid questionnaires. The data were collected by way of personal visits and investigations of outpatients in three regional hospitals in Taiwan. After the reliability and the validity of the questionnaire sample were examined, the data were verified by using hierarchical regression analysis. FINDINGS: Results showed that confidence benefit constituted the most pronounced factor for hospital customers. Confidence benefit, social benefit, and special treatment benefit were perceived by customers as the key factors that have a positive influence on relationship commitment. In particular, customers placing greater emphasis on confidence benefit tended to be less willing to establish relationship commitment. PRACTICE IMPLICATIONS: When health service managers develop marketing strategies using customer relational benefit, they will still need to enhance customer confidence benefit as one of the main ways of achieving future improvements. In the event where health service managers seek to install resources for establishing and maintaining a good relationship commitment with customers, the crucial factors of social and special treatment benefits should not be ignored when seeking to enhance the customers' perception of confidence benefit.

Exploring the impact of mentoring functions on job satisfaction and organizational commitment of new staff nurses.

BACKGROUND: Although previous studies proved that the implementation of mentoring program is beneficial for enhancing the nursing skills and attitudes, few researchers devoted to exploring the impact of mentoring functions on job satisfaction and organizational commitment of new nurses. In this research we aimed at examining the effects of mentoring functions on the job satisfaction and organizational commitment of new nurses in Taiwan's hospitals. METHODS: We employed self-administered questionnaires to collect research data and select new nurses from three regional hospitals as samples in Taiwan. In all, 306 nurse samples were obtained. We adopted a multiple regression analysis to test the impact of the mentoring functions. RESULTS: Results revealed that career development and role modeling functions have positive effects on the job satisfaction and organizational commitment of new nurses; however, the psychosocial support function was incapable of providing adequate explanation for these work outcomes. CONCLUSION: It is suggested in this study that nurse managers should improve the career development and role modeling functions of mentoring in order to enhance the job satisfaction and organizational commitment of new nurses.

Exploring medical utilization patterns of emergency department users.

BACKGROUND/PURPOSE: The intercategory relationship of various medical services is of importance to both health care management and policy-making. The purpose of this study was to explore the intercategory relationship of emergency medical services and other medical services and to examine the medical utilization patterns of emergency department (ED) users. METHODS: The sample was selected from the National Health Insurance Research Database in Taiwan for the year 2004. A total of 6775 patients who visited the ED were included. Multiple logistic regression analyses were performed to determine relationships between emergency medical services and other medical services, and cluster analysis characterized different medical utilization patterns of ED users. RESULTS: Frequent ED users (>or= 4 ED visits during the year) were more likely to use other health care services: their odds ratios (ORs) were 10.30 (95% confidence interval [CI], 7.53-14.10) for 11 or more visits to hospital outpatient departments, 1.51 (95% CI, 1.14-1.99) for 13 or more visits to primary care physicians, and 4.90 (95% CI, 3.74-6.43) for in-hospital care. Moreover, ED users fell into four medical utilization patterns: low health care users (61.91%), hospital fans (11.93%), primary care favorers (21.21%) and high health care users (4.95%). CONCLUSION: Frequent ED users also heavily used other health care services. ED users have different utilization patterns, which is a reflection of the unique needs for various health care services. Such knowledge is critically important for both health care providers and policy-makers who must meet the needs of different patient groups.

Determining factors of patient satisfaction for frequent users of emergency services in a medical center.

BACKGROUND: The present era of a competitive healthcare environment indicates that providers have been convinced that attentiveness to patient satisfaction is integral to care quality and market share. Patient satisfaction is especially critical for frequent users of the emergency department (ED). The aim of this study was to compare satisfaction of overall ED care between frequent and infrequent ED users, and to find out the factors determining satisfaction among the frequent ED users. METHODS: Frequent ED users (> or = 4 visits/per year) and infrequent ED users (< 4 visits/per year) were selected randomly from patients visiting the adult ED of a public tertiary medical center from October 1, 2000 to September 30, 2001. Retrospective telephone interviews were completed for 200 frequent users and 200 infrequent users. Ordinal logistic regression analysis was performed. RESULTS: Infrequent ED users tended to give a higher satisfaction rating than frequent ED users to emergency care (OR = 2.14; 95% CI = 1.40-3.25). The 2 significant determinants associated with satisfaction with emergency care among frequent ED users were discharge instructions (OR = 2.78; 95% CI = 1.27-6.12) and subjective waiting time (OR = 12.6; 95% CI = 4.22-37.8). CONCLUSIONS: The frequent ED users were unique, and their satisfaction with overall emergency care was significantly lower than that of infrequent ED users. Managing waiting time perceptions and providing discharge instructions may be an effective strategy to achieve improved patient satisfaction among frequent ED users.

Analysis of emergency department utilization by elderly patients under National Health Insurance.

Elderly persons are thought to use emergency departments (EDs) disproportionately. This phenomenon has implications for policy-making as the population of the elderly continues to increase. This study aimed to characterize national ED utilization by elderly patients (> or = 65 years old), compared with that by younger patients (15-64 years old). The sample was selected from the National Health Insurance Research Database for the year 2000. There were 519,003 visits to adult EDs in the 12 medical centers sampled. The study used a secondary data analysis and included 14 variables. The elderly accounted for 28.5% of all adult ED visits. Compared with younger patients, a greater proportion of elderly patients were male (61.6% vs. 47.7%, p < 0.001), had chronic diseases (11.9% vs. 8.0%, p < 0.001), were major cases (6.7% vs. 4.1%, p < 0.001), made no co-payment (38.5% vs. 5.8%, p < 0.001), were frequent users of outpatient services (28.4% vs. 9.9%, p < 0.001), were higher-level emergencies (60.0% vs. 43.7%, p < 0.001), had longer stays in the ED (14.0% vs. 4.7%, p < 0.001), and had higher costs per visit (NT dollars 4,814 +/- 6,046 vs. 2,779 +/- 5,533, p < 0.001). In addition, elderly patients used 40.8% of total adult ED costs. Older patients have distinct patterns of ED use, and use emergency services at a higher rate than younger patients. ED staff should be knowledgeable about the unique and complex presentations of older ED patients.