Notes on the data: Emergency Department presentations

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 [2]. Examples include people who are homeless or transient.

The Australian Institute of Health and Welfare, 2020 [1] report that in 2017-18 more than 8 million patients presented to Australian public hospital EDs — an average of about 22,000 patients per day. This was 3.4% higher than the previous year (compared with 2.7% growth per year between 2013–14 and 2017–18).

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 [3]. 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.

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].

Variation in the provision of Emergency Department services by capital city and rest of state/territory

The extent of variation in the provision of ED services counted in this collection is shown in Table 1, 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:

  • the range for Total presentations is from 26% below the national rate in Hobart and 20% below in Melbourne to 23% above in Darwin and 10% above in Canberra;
  • for Urgent presentations, the range is from 30% below in Hobart to 20% above in Brisbane and Canberra;
  • for Semi-urgent presentations, the range is from 26% below in Hobart and 24% below in Brisbane to 32% above in Darwin; and
  • for Non-urgent presentations, from 49% below in Brisbane and 44% below in Perth, to 11% above in Canberra and 8% above in Hobart.

For Rest of states/ NT:

  • the range for Total presentations is from 16% below the national rate in Rest of SA to 293% above in Rest of NT;
  • for Urgent presentations, the range is from 32% below the national rate in Rest of SA to 256% above in Rest of NT;
  • for Semi-urgent presentations, the range is from 20% below in Rest of Qld to 307% above in Rest of NT; and
  • for Non-urgent presentations, from 52% below in Rest of Qld, to 351% above in Rest of NT and 307% above in Rest of NSW.
All Rest of States/ NT121111127165
Table 1: Variations in age-standardised rates, expressed as an index, of Emergency Department presentations, 2017/18 (Australia = 100).
Section of States/ NT Total Urgent Semi-urgent Non-urgent
Australia 100 100 100 100
All capital cities 89 94 86 67
Sydney 88 88 86 80
Melbourne 80 85 81 64
Brisbane 97 120 76 51
Adelaide 94 97 85 60
Perth 96 91 105 56
Hobart 74 70 74 108
Darwin 123 109 132 59
Canberra 110 120 109 111
Rest of NSW 159 126 176 307
Rest of Vic 99 92 107 116
Rest of Qld 92 110 80 48
Rest of SA 84 68 102 118
Rest of WA 127 108 146 162
Rest of Tas 118 111 140 124
Rest of NT 293 256 307 351

 

Emergency Department presentations by Chapter and Triage category

The dataset was split by ICD-10-AM Chapter and triage category (Table 2) to create 60 indicators of different type and severity. 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 2 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, the Resuscitation and Emergency triage categories were aggregated for 6 chapters where presentations for Resuscitation were less than 3,000. These were for chapters: Certain infectious and parasitic diseases, Mental and behavioural disorders, Diseases of the digestive system, Diseases of the musculoskeletal system and connective tissue, Diseases of the genitourinary system and Factors influencing health status and contact with health services.

Table 2: Emergency Department presentations by ICD-10-AM Chapter and Triage category for 2017/2018
ICD-10-AM Chapter Resuscitation: Immediate (within seconds) Emergency (within 10 minutes) Resuscitation and Emergency (within 10 minutes) Urgent (Within 30 minutes) Semi-Urgent (Within 60 minutes) Non-urgent (within 120 minutes) Total
Certain infectious and parasitic diseases - - 35,127 169,520 178,784 16,732 400,163
Mental and behavioural disorders - - 41,644 134,744 79,808 16,305 272,501
Diseases of the circulatory system 13,777 144,860 - 126,893 45,598 5,952 337,080
Diseases of the respiratory system 7,726 124,709 - 290,715 180,159 16,874 620,183
Diseases of the digestive system - - 36,748 209,759 159,549 16,335 422,391
Diseases of the musculoskeletal system and connective tissue - - 17,328 103,614 205,947 39,610 366,499
Diseases of the genitourinary system - - 35,122 152,904 114,566 10,995 313,587
Injury, poisoning and certain other consequences of external causes 14,995 152,909 - 515,714 1,007,183 246,512 1,937,313
Factors influencing health status and contact with health services - - 23,662 85,804 150,285 130,521 390,272
Other 13,703 409,736 - 1,080,037 861,781 144,264 2,509,521
Total 57,648 1,014,398 n.a. 2,869,704 2,983,660 644,100 7,569,510

 

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. 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.
  2. Ford G. The role of the Emergency Department as a 'safety net'. Health Issues 2002;73:29-32.
  3. Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2011-12. Health services series no. 50. (Cat. no. HSE 134.) Canberra: AIHW; 2013.
 

Confidentiality of data

Counts of less than five presentations have been suppressed.

The population health areas of 30057 Brisbane Inner - North - Central and 30051 Fortitude Valley/Spring Hill have been combined at the request of Queensland Health; data displayed is the combination of values and rates for these areas.

 

Geography: Data available by Population Health Area, Local Government Area, Primary Health Network, Quintiles of socioeconomic disadvantage of area and Remoteness Areas.

 

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

 

Denominator:  Total population.

 

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

 

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; and ABS Estimated Resident Population, average of 30 June 2017 and 2018.

 

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