Notes on the data: Emergency department presentations

Indigenous Emergency department presentations, 2017/18

 

Policy context:  Public hospital emergency departments (ED) are accessible 24 hours a day, seven days a week, to provide acute and emergency care to patients arriving either by ambulance or by other means. While some people require immediate attention for life threatening conditions or trauma, most require less urgent care.

Timely access to care is a high priority for patients, health care providers and the public at large. Although there needs to be an appropriate balance between primary and acute care, EDs play an important role as a safety net in the health system, providing care to people who are unable to access services elsewhere (especially after hours) including care from general practitioners [1]. Examples include people who are homeless or transient, and Aboriginal and Torres Strait Islanders.

An ED service event can be commenced by a doctor, nurse, mental health practitioner or other health professional, when investigation, care and/or treatment is provided in accordance with an established clinical pathway defined by the ED [2]. The data include both presentations at formal EDs and emergency occasions of service provided through other arrangements, particularly in smaller hospitals located in regional and remote areas.

In 2017–18, about 6.7% of ED presentations (535,000) were for Aboriginal and Torres Strait Islander people (Indigenous Australians), who represent about 3.5% of the Australian population [3]. The Australian Institute of Health and Welfare report [4] that the average access to General Practitioners relative to need decreases with remoteness for the Indigenous population. This is due to the worsening access to General Practitioners from metropolitan to remote areas and the increasing predicted need for primary health care based on the Indigenous population’s demographic structure which also varies across the remoteness gradient. This trend poses health care issues for the Indigenous population since a large proportion of the population live outside metropolitan areas. These factors lead to hospitals, particularly Emergency Departments, becoming the primary health service provider for many in the Indigenous population, although such services are not always available to Indigenous communities.

Of note, is that the quality of the data reported for Indigenous status in emergency departments has not been formally assessed—therefore, caution should be exercised when interpreting these data. In addition, the AIHW’s National Non-admitted Patient Emergency Department Care Database (NNAPEDCD) does not include all emergency department activity in remote areas and this is likely to affect reporting of data for Indigenous Australians who account for a higher proportion of the population in these areas [3]. Given this statement, all states and territories consider the Indigenous status data to be of a quality appropriate for publication. Indigenous status was not reported for fewer than 1% of ED presentations in 2017–18 [3].

Caveat:   Although there are national standards for data on non-admitted patient ED services, the way those services are defined and counted varies across states and territories [1]. One of the most notable variations is the very large number of hospitals in New South Wales with ED services categorised as ‘Other hospitals’. All but one of the 87 hospitals in this category providing ED services were in New South Wales; in comparison, the large majority of public acute hospitals providing ED services in other states and territories were in one of the categories of Public acute hospitals Group A, B or C (see Appendix C, Table A3 [1]).

As a result, New South Wales had 62% of the nation’s public hospitals with ED services, compared with 36% of presentations. Hospitals in the ‘Other hospitals’ category tend to have a greater proportion of non-acute separations compared with the larger acute public hospitals [1]. These variations become particularly evident when viewing the data by small geographic area across Australia. Maps of presentations for Semi-urgent and Non-urgent triage categories show that presentation rates in regional and remote areas in NSW were considerably higher than the national average (see also Table 1). In addition, there is also considerable variation in access within the States and Territories. As a result, while comparisons between capital cities are appropriate, comparisons between areas outside of capital cities between the states and territories should not be made. To assist users in relating variations in rates of presentations to issues of access, the interactive atlases include the locations of the 286 hospitals with ED facilities. These facilities were geocoded from the listing reported by the Australian Institute of Health and Welfare [1].

It should be noted that data is based on a persons' area of residence and as such anomalies will occur due to cross state/territory border movements of patients.

Publishing of Queensland data by Indigenous Area

As requested by Queensland Health, the Indigenous Area (IAREs) below were combined to ensure confidentiality.

Table 1: The codes and names of Queensland Indigenous Areas which have been combined to form the adjusted Indigenous areas.
Indigenous Area Code Indigenous Area Name Indigenous Area Name - Adjusted
305001 Banana Banana - North Burnett
305008 North Burnett Banana - North Burnett
304001 Boulia - Diamantina - Winton Boulia - Diamantina - Winton - Cloncurry - McKinlay
304003 Cloncurry - McKinlay Boulia - Diamantina - Winton - Cloncurry - McKinlay
302002 Cairns Cairns - Yarrabah
302003 Cairns - Far North Coast Cairns - Yarrabah
302004 Cairns - Southern Hinterlands Cairns - Yarrabah
302011 Yarrabah Cairns - Yarrabah
305002 Barcaldine - Blackall - Longreach Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
305004 Central Capricorn Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
305007 Nebo - Clermont Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
306003 Cherbourg Murgon - Cherbourg - South Burnett
306013 South Burnett Murgon - Cherbourg - South Burnett
306009 Murgon Murgon - Cherbourg - South Burnett
301005 Esk - Kilcoy Esk - Kilcoy - Nanango - Kilkivan
306011 Nanango - Kilkivan Esk - Kilcoy - Nanango - Kilkivan
308003 Charters Towers Flinders - Richmond - Dalrymple - Charters Towers
308004 Flinders - Richmond - Dalrymple Flinders - Richmond - Dalrymple - Charters Towers
308005 Ingham - Hinchinbrook Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
302007 Innisfail - Johnstone Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
308009 Palm Island Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
308015 Tully - Cardwell - Jumbun Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
302001 Atherton Atherton - Eacham - Herberton - Ravenshoe
302005 Eacham Atherton - Eacham - Herberton - Ravenshoe
302006 Herberton - Ravenshoe Atherton - Eacham - Herberton - Ravenshoe
302008 Kuranda - Croydon Kuranda - Croydon - Mareeba
302009 Mareeba Kuranda - Croydon - Mareeba
308006 Mackay Mackay - Sarina - Mirani
308007 Mackay - Surrounds Mackay - Sarina - Mirani
308008 Mirani Mackay - Sarina - Mirani
308011 Sarina Mackay - Sarina - Mirani
306001 Balonne Maranoa - Roma - Mitchell - Balonne
306008 Maranoa - Roma - Mitchell Maranoa - Roma - Mitchell - Balonne
306002 Bulloo - Quilpie - Barcoo Murweh - Paroo - Bulloo - Quilpie - Barcoo
306010 Murweh Murweh - Paroo - Bulloo - Quilpie - Barcoo
306012 Paroo Murweh - Paroo - Bulloo - Quilpie - Barcoo
306004 Cooloola - Gympie Noosa - Cooloola - Gympie
301011 Noosa Noosa - Cooloola - Gympie
304002 Carpentaria - Burke - Mornington Northern Peninsula Area - Cape York - Carpentaria
303001 Aurukun Northern Peninsula Area - Cape York - Carpentaria
303002 Cape York Northern Peninsula Area - Cape York - Carpentaria
303003 Cooktown Northern Peninsula Area - Cape York - Carpentaria
303004 Hope Vale Northern Peninsula Area - Cape York - Carpentaria
307001 Kaiwalagal - Inner Islands Northern Peninsula Area - Cape York - Carpentaria
307002 Kalakawal - Top Western Islands Northern Peninsula Area - Cape York - Carpentaria
307003 Kalalagal - Western Islands Northern Peninsula Area - Cape York - Carpentaria
303005 Kowanyama Northern Peninsula Area - Cape York - Carpentaria
307004 Kulkalgal - Central Islands Northern Peninsula Area - Cape York - Carpentaria
303006 Lockhart River Northern Peninsula Area - Cape York - Carpentaria
303007 Mapoon - Napranum - Weipa Northern Peninsula Area - Cape York - Carpentaria
307005 Meriam - Eastern Islands Northern Peninsula Area - Cape York - Carpentaria
303008 Northern Peninsula Area Northern Peninsula Area - Cape York - Carpentaria
303009 Pormpuraaw Northern Peninsula Area - Cape York - Carpentaria
302010 Wujal Wujal and Outstations Northern Peninsula Area - Cape York - Carpentaria
308001 Bowen (Qld) Proserpine - Whitsunday - Bowen (Qld)
308010 Proserpine - Whitsunday Proserpine - Whitsunday - Bowen (Qld)
301012 Pine Rivers Redcliffe - Pine Rivers
301013 Redcliffe Redcliffe - Pine Rivers
301001 Beaudesert - Boonah Southern Downs - Beaudesert - Boonah
306014 Southern Downs Southern Downs - Beaudesert - Boonah
301006 Gatton - Laidley Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306007 Jondaryan - Oakey Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306015 Toowoomba - Central Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306016 Toowoomba - North Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306017 Toowoomba - South Toowoomba - Jondaryan - Oakey - Gatton - Laidley
308002 Burdekin - Ayr Townsville - Burdekin - Ayr
308013 Townsville Townsville - Burdekin - Ayr
308014 Townsville - Surrounds Townsville - Burdekin - Ayr
306005 Dalby Western Downs - Dalby - Goondiwindi - Stanthorpe
306006 Goondiwindi - Stanthorpe Western Downs - Dalby - Goondiwindi - Stanthorpe
306018 Western Downs Western Downs - Dalby - Goondiwindi - Stanthorpe

The variation in the provision of Emergency Department services by capital city and rest of state/territory to Indigenous people

The extent of variation in the provision of Emergency Department services counted in this collection is shown in Table 2, where the age-standardised rate of presentations for Australia has been set as 100, and the rates in the capital cities and Rest of State/ NT areas (the areas outside of the capital cities) are shown as an index number relative to the Australian rate.

Some highlights from the table are noted below.

For capital cities:

  • Total presentations were 21% below the national rate,
  • Non-urgent presentations were 53% below the national rate,
  • the range for Total presentations is from 56% below the national rate in Hobart, 27% below in Sydney and 34% below in Melbourne to 6% above in Darwin,
  • the range of Resuscitation and Emergency presentations is from 69% above in Darwin, 21% above in Adelaide to 25% and 65% below in Melbourne and Hobart, respectively,
  • for Urgent presentations , the range is from 57% below in Hobart, around 20% below in Sydney and Melbourne to 19% above in Canberra,
  • for Semi-urgent presentations , the range is from 56% below in Hobart, 46% below in Brisbane to 12% above in Darwin; and
  • for Non-urgent presentations , all capital cities were below the national rate.

For Rest of states/ NT:

  • Total presentations were 12% above the national rate,
  • the range for Total presentations is from 44% below the national rate in Rest of Tasmania to 47% above in Rest of Northern Territory,
  • the range of Resuscitation and Emergency presentations is from 68% above in the Rest of Northern Territory to 67% below in the Rest of Tasmania,
  • for Urgent presentations , the range is from 44% below the national rate in Rest of Tasmania to 46% above in Rest of Northern Territory,
  • for Semi-urgent presentations , the range is from 35% below in both the Rest of Queensland and Rest of Tasmania to over 45% for the Rest of New South Wales, Rest of Western Australia and Rest of Northern Territory and
  • for Non-urgent presentations , from 65% below in Rest of Queensland to 61% above in the Rest of Western Australia and 117% above in Rest of New South Wales.
Table 2: Variations in age-standardised rates, expressed as an index, of Emergency Department presentations for Indigenous people, 2017/18. (Australia = 100).
Section of States/ NT Total presentations Resuscitation and Emergency presentations Urgent presentations Semi-urgent presentations Non-urgent presentations
Australia 100 100 100 100 100
All capital cities 79 101 90 71 47
Rest of States/NT 112 99 105 116 130
Sydney 73 85 79 69 53
Melbourne 66 75 80 60 37
Brisbane 76 112 103 54 33
Adelaide 94 121 111 81 57
Perth 91 116 92 93 53
Hobart 44 35 43 44 56
Darwin 106 169 96 112 41
Canberra 101 80 119 97 85
Rest of NSW 135 98 111 145 217
Rest of Vic 105 98 101 110 108
Rest of Qld 73 88 90 65 35
Rest of SA 100 73 91 106 137
Rest of WA 128 94 108 146 161
Rest of Tas 56 33 56 65 53
Rest of NT 147 168 146 151 109

 

Emergency Department presentations by Chapter and Triage category for Indigenous people

TThe dataset was split by ICD-10-AM Chapter and triage category (Table 2) to create 39 indicators by ICD-10-AM Chapter and Triage category. The ICD-10-AM chapter is categorised from the ICD-10 codes as reported in each patient's principal diagnosis. The Triage category is assigned to a patient by the ED to indicate the urgency of the patient’s need for medical and nursing care.

Table 3 shows the distribution and number of records used to create the atlases by ICD-10-AM Chapter and Triage categories. To achieve the numbers required to present information without a large degree of confidentilisation at the IARE level, certain Triage categories were aggregated together.

Table 3: Emergency Department presentations by ICD-10-AM Chapter and Triage category for Indigenous people, 2017/2018
ICD-10-AM Chapter Resuscitation and Emergency (within 10 minutes) Urgent (Within 30 minutes) Resuscitation, Emergency and Urgent Presentations Semi-Urgent (Within 60 minutes) Non-urgent (within 120 minutes) Semi-urgent and Non-urgent (within 120 minutes) Total
Certain infectious and parasitic diseases - - 12,505 - - 13,792 26,297
Mental and behavioural disorders - - 17,901 - - 11,133 29,034
Diseases of the circulatory system - - - - - - 12,535
Diseases of the respiratory system 9,553 22,280 - - - 18,789 50,622
Diseases of the digestive system - - 13,980 - - 13,969 27,949
Diseases of the musculoskeletal system and connective tissue - - 6,891 - - 16,342 23,233
Diseases of the genitourinary system - - 9,817 - - 8,253 18,070
Injury, poisoning and certain other consequences of external causes 9,680 29,392 - 60,018 16,344 - 115,434
Factors influencing health status and contact with health services - - 8,734 14,654 13,848 - 37,236
Other 24,469 60,980 - 59,027 10,974 - 155,450
Total 63,724 172,804 n.a. 206,284 53,048 n.a. 495,860

 

n.a. – not applicable, resuscitation and emergency totals recorded in their corresponding triage category totals.

Detailed information on the Emergency Department dataset

The data include presentations to EDs between 1 July 2017 and 30 June 2018. The data presented are sourced from the AIHW’s National Non-admitted Patient Emergency Department Care Database (NNAPEDCD), which is based on the Non-admitted Patient Emergency Department Care (NAPEDC) National Minimum Data Set/National Best Endeavours Data Set (NMDS/NBEDS). The NNAPEDCD provides information on the care provided for non-admitted patients registered for care in EDs in public hospitals where the ED meets the following criteria:

  • a purposely designed and equipped area with designated assessment, treatment, and resuscitation areas
  • the ability to provide resuscitation, stabilisation, and initial management of all emergencies
  • availability of medical staff in the hospital 24 hours a day
  • designated emergency department nursing staff 24 hours per day 7 days per week, and a designated emergency department nursing unit manager.

Emergency departments (including ‘accident and emergency’ or ‘urgent care centres’) that do not meet the criteria above are not in scope for the NMDS, but data may have been provided for some of these by some states and territories [1].

The coverage of the NNAPEDCD was considered complete for public hospitals which meet the above criteria. The collection does not include all emergency services provided in Australia; for example, emergency service activity provided by private hospitals, or by public hospitals which do not have an ED that meets the above criteria are excluded. This should be taken into account, particularly when comparing data between urban and regional areas, or by Remoteness Area. States and territories provided Emergency Department diagnosis information in several classifications, including SNOMED CT-AU, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM); and various editions of ICD-10-AM. For the purpose of reporting principal diagnoses, the AIHW mapped the provided information to ICD-10-AM 10th edition codes, where necessary.

Chapter ICD-10-AM definitions

Any of the reported principal diagnosis as per the below:

  1. A00–B99 (Certain infectious and parasitic diseases)
  2. F00–F99 (Mental and behavioural disorders)
  3. I00–I99 (Diseases of the circulatory system)
  4. J00–J99 (Diseases of the respiratory system)
  5. K00–K93 (Diseases of the digestive system)
  6. M00–M99 (Diseases of the musculoskeletal system and connective tissue)
  7. N00–N99 (Diseases of the genitourinary system)
  8. S00–T98 (Injury, poisoning and certain other consequences of external causes)
  9. Z00–Z99 (Factors influencing health status and contact with health services).
  10. C00–D48, D50–D89, E00–E90, G00–G99, H00–H59, H60–H95, L00–L99, O00–O99, P00–P96, Q00–Q99, R00–R99, U50–Y98 (Other).

References

  1. Ford G. The role of the Emergency Department as a 'safety net'. Health Issues 2002;73:29-32.
  2. Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2011-12. Health services series no. 50. (Cat. no. HSE 134.) Canberra: AIHW; 2013.
  3. Australian Institute of Health and Welfare (AIHW). Emergency department care 2017–18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW; 2018.
  4. Australian Institute of Health and Welfare 2014. Access to primary health care relative to need for Indigenous Australians. Cat. no. IHW 128. Canberra: AIHW.
 

Confidentiality of data

Counts of less than five presentations have been suppressed.

Specific Indigenous Areas within Queensland have been aggregated on the request of Queensland Health; data displayed is the combination of values and rates for these areas.

 

Geography: Data available by Indigenous Area, Primary Health Network, Indigenous Quintiles and Indigenous Remoteness Areas.

 

Numerator:  Presentations by Indigenous people to Emergency Departments by Totals, ICD-10-AM Chapter and Triage category (where available).

 

Denominator:  2016 Indigenous population

 

Detail of analysis:  Indirectly age-standardised rate per 100,000 Indigenous population; and/or indirectly age-standardised ratio, based on the Australian standard derived from an Indigenous population.

 

Source:  Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2017/18; he population is the proportional estimated resident population (erp) from the Australian Census 2016 click herefor more details.

 

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