News

EDs continue to be clogged with non-urgent presentations


Morgan Liotta


2/07/2020 2:35:43 PM

One-third of presentations classified as lower urgency could be managed by a GP – and the trend is persisting – a new report confirms.

Hospital emergency department sign
Of all hospital emergency department presentations in 2018–19, 2.9 million were for lower urgency care.

Latest data* from the Australian Institute of Health and Welfare (AIHW reveals that 2.9 million (35%) emergency department (ED) presentations were for lower urgency care in 2018–19.
 
Despite this figure being slightly down from 38% in 2015–16, the relatively stable rate has remained a further indicator that a large portion of ED presentations could be managed by a GP or community health service, freeing up hospitals for more urgent care.
 
The RACGP has long held the stance that GPs are ideally placed to manage lower-urgency cases, which can often overwhelm EDs, and that better support for general practice would help to reduce such avoidable presentations.
 
‘You would like to have your emergency departments for emergencies,’ RACGP President Dr Harry Nespolon told The Australian.
 
‘So rather than having a whole lot of staff tied up with medical problems that could either be dealt with the next day in general practice or outside of the hospital system, these patients are in there waiting to be seen.’
 
Lower urgency ED care is defined by the AIHW as presentations where the person:

  • was assessed as needing semi-urgent (triage category 4: should be seen within one hour) or non-urgent care (category 5: should be seen within two hours)
  • did not arrive by ambulance, or police or correctional vehicle
  • was not admitted to the hospital, was not referred to another hospital, and did not die.
The Australian Bureau of Statistics’ Patient Experience Survey 2018–19 found that 16.8% of respondents aged 15 and over who visited an ED for any reason thought their care could have been provided by a GP.
 
This proportion has remained largely unchanged since 2015–16, at 17.9%.
 
Recent figures also revealed that up to 40% of all ED presentations in Western Australia and South Australia could be instead managed by GPs.
 
According to the AIHW, the main reason most people went to an ED instead of a GP was because they were taken by ambulance, the condition was serious, or they were sent by a GP (58%).
 
One in five (21%) reported the main reason was because a GP was not available when required, and less than 1% indicated cost as the main reason.
 
Dr Nespolon believes access to healthcare can be influenced by the cost of seeing a GP, but is dependent on age cohorts.
 
‘If you look at the people who tend to show up [at EDs], they are the under-65s – they are usually people who have to pay a gap fee at their GP,’ he said.
 
‘The people GPs are likely to charge are the people who can afford to pay … so not surprisingly that group of people [the under-25s], presumably purely for financial reasons, are going off to casualty.’
 
Rates of lower-urgency ED presentations were greater for young people and children, with 45% of people aged under 25 accounting for 1.3 million presentations. Children aged under 15 represented 29% (852,000 presentations) of all lower urgency cases.
 
People aged 65 and over accounted for 11%, or 312,000 presentations.
 
Almost half (47%) of all lower-urgency ED presentations were after-hours, with people aged under 65 more likely to present after-hours (48% from this age group) than people aged 65 and over (39%).
 
This proportion has slightly decreased for both cohorts since 2015–16, down from 50% for under-65s and 41% for 65 and over.
 
People in regional Primary Health Networks (PHNs) areas continue to receive lower-urgency ED care more than people in metropolitan PHN areas.
 
There were 164 presentations per 1000 people in 2018−19 in regional PHNs, compared to 90 per 1000 people in metropolitan PHNs.
 
People from regional areas triaged as ‘non-urgent’ were less likely to be admitted to hospital,
with one in 20 admitted (5.4%, or 33,000 presentations) compared to one in five triaged as ‘semi-urgent’ admitted (18%, or 572,000 presentations).
 
People living in metropolitan PHN areas who were triaged as ‘non-urgent’ were more likely to be admitted to hospital (6.7% of presentations) than their regional counterparts (4.4%).
 
Western NSW PHN has consistently had the highest presentation rate of lower-urgency cases since 2015, with 103,390 presentations in 2018–19.

*The AIHW data for this report precedes COVID-19.

Log in below to join the conversation.



emergency departments hospitals non-urgent presentations PHNs



Login to comment

Dr Horst Paul Herb   4/07/2020 12:50:21 AM

Any conclusion or study relying on triage categories assigned in Australian EDs can be redirected straight into the rubbish bin.

Us experienced doctors are despairing over inexperienced junior nurses assigning triage categories that only occasionally match our expectations. A very obvious reflux "chest pain" in a young healthy patient joking with others in the waiting rooms will usually be a "2" and really should be seen by a GP, whereas I rarely work a day in ED where seriously ill patients end up getting a triage category 4 or 5 because the inexperienced "triagist" failed to elicit the red flags.

We often joke about "the triage lottery" - for a good reason.

Shame on "academics" relying on triage categories without individual review (and reassignment) of triage categories - they merely demonstrate that they are clueless regarding real world medicine. Sadly, their reports all too often "inform" political decisions ...


Dr Ian Mark Light   4/07/2020 7:03:36 PM

General Practices are inhibited from triage of any infectious disease because of the Covid 19 fear and there is still an undersupply of Personal Protection Equipment no supplies of Covid testing but more it is unclear what happens to a surgery if a patient who has entered into a waiting room or consulting rooms and tests positive for Covid 19
How much of the Surgery is shut down ?


Dr Horst Paul Herb   5/07/2020 7:47:36 PM

Any conclusion or study relying on triage categories assigned in Australian EDs can be redirected straight into the rubbish bin.

Us experienced doctors are despairing over inexperienced junior nurses assigning triage categories that only occasionally match our expectations. A very obvious reflux "chest pain" in a young healthy patient joking with others in the waiting rooms will usually be a "2" and really should be seen by a GP, whereas I rarely work a day in ED where seriously ill patients end up getting a triage category 4 or 5 because the inexperienced "triagist" failed to elicit the red flags.

We often joke about "the triage lottery" - for a good reason.

Shame on "academics" relying on triage categories without individual review (and reassignment) of triage categories - they merely demonstrate that they are clueless regarding real world medicine. Sadly, their reports all too often "inform" political decisions ...