Background: Nursing home (NH) residents are frequently transferred to the emergency department (ED) but there is little data on inter-facility variation, which has implications for intervention planning and implementation.

Objectives: To describe variation in ED transfer rates (TRs) across NHs and the association with NH characteristics.

Design/setting: Retrospective cohort study using linked administrative data from Ontario.

Participants: 71,780 residents of 604 NHs in 2010 and followed for one year.

Measurements: Funnel plots were used to identify high transfer NHs and logistic regression to test the association with NH location, size, ownership and historical ED transfer rate.

Results: One-year ED transfer rates ranged from 4.3% to 58.6% (mean 28.4%); 115 (19%) NHs were considered high. Being within five minutes of an ED, larger size and high historical ED transfer rate were associated with being a high ED transfer home.

Conclusion: There was substantial variation across NHs. Consideration of characteristics such as proximity to an ED may be important in the development and targeting of different interventions for NHs.