New studies examine Australian ED presentations

Morgan Liotta

1/03/2019 1:19:36 PM

The AIHW has examined eight million ED presentations, while a new study has found 20–40% of patients in WA could have been managed by a GP.

Between 2017–18, there was an average of 22,000 emergency department presentations per day.
Between 2017–18, there was an average of 22,000 emergency department presentations per day.

The Australian Institute of Health and Welfare (AIHW) report, Emergency department care 2017–18, shows that eight million patients presented to hospital emergency departments (EDs) between July 2017 and June 2018, with an average of 22,000 presentations per day.
Seventy one per cent of ED presentations were completed within four hours and 90% of patients completed their ED stay within eight hours, while 31% were subsequently admitted to the hospital, the report reveals.
The most common reason for ED presentations varied by states and territories, triage category, admission status and age group. But the most common principal diagnosis was ‘injury, poisoning and certain other consequences of external causes’ based on the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), accounting for 25% of all presentations.
The second most common ICD-10-AM principal diagnosis was ‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified’, accounting for 21% of presentations.
Waiting times for patients also varied across states and territories and triage categories:

  • Almost 100% of ‘resuscitation’ patients were seen on time (immediately)
  • 76% of ‘emergency’ patients were seen within 10 minutes
  • 64% of ‘urgent’ patients were seen within 30 minutes
  • 73% of ‘semi-urgent’ patients were seen within one hour
  • 92% of ‘non-urgent’ patients were seen within two hours
The AIHW report also reveals that older people are substantially represented in ED presentations, with 22% of all presentations in 2017­–18 patients aged 65 and over (close to 15% of the nation’s population).
The Australian Health Review published an article in 2018 on the over representation of older people in EDs, showing that almost 14% of these presentations were classified as ‘potentially avoidable’, where the patient could have instead gone to a GP.
Professor Danielle Mazza, lead research author of the article and member of the RACGP Expert Committee – Quality Care, previously told newsGP there is a need to focus on chronic disease management in general practice and to use ED presentations as a ‘marker that additional care may be required, particularly in older patients and frequent ED attendees’.
Meanwhile, a recent study published in Emergency Medicine Australasia found that 20–40% of all ED presentations in Western Australia could have been instead managed by GPs.
Associate Professor Alistair Vickery was lead author of this study, which was the first in Australia to place GPs in EDs. He said the increasing burden of ED presentations is contributing to overcrowding, long delays in care and inefficiencies in WA’s hospitals.
‘The 2019 Productivity Commission report suggests that there were almost three million avoidable ED presentations in 2018 in Australia, where people who should have seen a GP went to the ED instead,’ Associate Professor Vickery said.
The study determined that 80% of patients assessed were ‘primary care-type’ ED presentations, with one‐third of these considered more suitable for general practices, if additional resources were available. 
‘This study was the first to involve GPs clinically assessing patients presenting to ED to determine whether, in their opinion, the patient could have been managed in general practice,’ Associate Professor Vickery said.

AIHW emergency department hospital stay older people

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