Summary
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Emergency departments (EDs) are a vital part of Australia’s health care system; they provide care for people who require urgent, and often life-saving, medical attention. People who attend EDs are managed according to the condition they are presenting with to ensure that the most urgent cases are dealt with most quickly. People are triaged into 1 of 5 categories on the Australasian Triage Scale (ACS). These vary on how soon people presenting to the ED need medical and/or nursing care. These categories are:
- Triage category 1 (Resuscitation): patient should be seen immediately (within seconds)
- Triage category 2 (Emergency): patient should be seen within 10 minutes
- Triage category 3 (Urgent): patient should be seen within 30 minutes
- Triage category 4 (Semi-urgent): patient should be seen within 60 minutes
- Triage category 5 (Non-urgent): patient should be seen within 120 minutes.
Understanding who uses emergency care services can inform health care planning, coordination, and delivery to ensure that people receive the best care for their circumstances.
The first section of this report explores ED presentations referred to as lower urgency care (Box 1). In 2021–22, about one-third of ED presentations were classified as lower urgency and about 4 in 10 of all lower urgency ED presentations were by people aged under 25.
Additional measures to understand the number of ED presentations per hour, arrivals by ambulance, and admissions to hospital by triage category have been included in the data tables to help inform services and initiatives which aim to ensure the best care for patients presenting for lower urgency care.
Box 1: What is lower urgency care?
Lower urgency ED presentations are defined as presentations at formal public hospital EDs where the person:
- had a type of visit to the ED of Emergency presentation
- had a triage category of semi-urgent (triage category 4: should be seen within 60 minutes) or non-urgent care (triage category 5: should be seen within 120 minutes)
- did not arrive by ambulance, or police or correctional vehicle
- was not admitted to the hospital, not referred to another hospital, and did not die.
These types of presentations are sometimes referred to as ‘avoidable GP type’ or ‘GP style’ however, there is nothing in the indicator specification that enables this kind of characterisation and so we do not present them as such. The indicator is based on the Australian College of Emergency Medicine’s Australasian Triage Scale for assessing emergency department patients. Further, more detailed work would need to be done, including by looking at various factors that influence the most appropriate model of care for such presentations, including for example the complexity of a presentation and the patient’s choice or condition.
Why measure lower urgency ED presentations?
Understanding how and when people use EDs can help to improve decision-making, service planning, and care coordination.
ED presentations that are lower urgency are sometimes used as a proxy measure of access to primary health care because some patients presenting in these categories may be better managed elsewhere in the health system. However, this measure is based only on the categories of the Australasian Triage Scale, which reflects urgency and does not reflect the complexity or severity of a person’s health condition, nor does it identify the most appropriate and cost-efficient model of care for the patient or in that region.
It is important not to assume that all lower urgency ED presentations could be more appropriately or efficiently treated in another setting. For instance, someone who fractures their arm may be more appropriately treated at an ED that has access to diagnostic imaging tests not readily available in all other settings.
Rates of lower urgency care admissions
Around 1 in 3 ED presentations (36%, or 3.1 million) were classified as lower urgency in 2021–22. ED presentations classified as lower urgency remained steady since 2020–21 (37%, or 3.2 million).
Higher rates of lower urgency presentations among children and young people
Around 4 in 10 lower urgency ED presentations in 2021–22 (42% or 1.3 million) were for people aged under 25. Children under 15 represented nearly 3 in 10 (26% or 807,000) lower urgency ED presentations and was the age group with the highest presentation rate (170 per 1,000 people). Conversely, people aged 65 and over accounted for about 1 in 10 (11%) lower urgency ED presentations (326,000 presentations, a rate of 74 per 1,000 people) (Figure 1).
Figure 1: Lower urgency ED presentations per 1,000 people, by age group, all-hours, 2021–22
Younger people were more likely than older people to present to ED for presentations that were considered lower urgency in 2021–22.
| Age group | Presentations per 1,000 people |
|---|---|
| 0–14 | 169.8 |
| 15–24 | 157.3 |
| 25–44 | 124.7 |
| 45–64 | 90.7 |
| 65–79 | 75.8 |
| 80+ | 70 |
About the measure
In this data update, the PHN Program Performance and Quality Framework indicator, Rate of GP style emergency department presentations, is referred to as ED presentations for lower urgency care. It is based on the National Healthcare Agreement specifications PI 19-Selected potentially avoidable GP-type presentations to emergency departments.
The PI 19 definition is for presentations at formal public hospital EDs where the patient:
- had an Emergency presentation type of visit
- had a triage category of 4 (semi-urgent) or 5 (non-urgent)
- did not arrive by ambulance, or police or correctional vehicle
- was not admitted to the hospital, not referred to another hospital, or did not die.
Presentations without these details (e.g. not stated arrival mode or episode end status) were excluded.
The following methodological issues should be considered when interpreting this data:
- Care should be taken when using this data to identify ‘avoidable GP type’ or ‘GP style’ presentations because it is based on urgency (triage) categories which may not reflect the various factors that influence the use of EDs such as the complexity of a presentation, the patient’s choice or condition, the most appropriate model of care for such presentations, or the accessibility and availability of primary and community health services.
- The NNAPEDCD is restricted to formal public EDs, and as such does not include all emergency or urgent care provided in Australian hospitals. In particular, this may affect comparability of results for regional and remote areas.
- Although there are national standards for data on non-admitted patient ED presentations, the way those presentations are defined and counted varies across states and territories, and over time, which may affect comparability across local areas.
Further information
For full details about the method, see the accompanying Technical notes.
Source:
AIHW analysis of the National Non-admitted Patient Emergency Department Care Database (NNAPEDCD) 2021–22.
Less than half of all lower urgency ED presentations were after-hours
In 2021–22 over 4 in 10 (45%) lower urgency ED presentations occurred when general practices and other alternate health services are usually closed (after-hours, see Box 2). People aged under 65 were more likely to present to ED after-hours (45% of presentations for this age group) for presentations considered lower urgency, than people aged 65 and over (37% of presentations for this age group). Since 2020–21, the proportion of after-hours presentations for lower urgency care has remained steady (Figure 2; Box 2).
Figure 2: Proportion (%) of lower urgency ED presentations that occurred after-hours, by age group, 2020–21 and 2021–22
In 2020–21 and 2021–22, people aged under 65 were more likely to present to ED after-hours for lower urgency presentations than people aged 65 and over.
| Age group | 2020–21 | 2021–22 |
|---|---|---|
| Under 65 | 44% | 45.4% |
| 65 years and over | 36.5% | 36.9% |
About the measure
In this data update, the PHN Program Performance and Quality Framework indicator, Rate of GP style emergency department presentations, is referred to as ED presentations for lower urgency care. It is based on the National Healthcare Agreement specifications 'PI 19-Selected potentially avoidable GP-type presentations to emergency departments'.
The PI 19 definition is for presentations at formal public hospital EDs where the patient:
- had an Emergency presentation type of visit
- had a triage category of 4 (semi-urgent) or 5 (non-urgent)
- did not arrive by ambulance, or police or correctional vehicle
- was not admitted to the hospital, not referred to another hospital, or did not die.
Presentations without these details (e.g. not stated arrival mode or episode end status) were excluded.
The following methodological issues should be considered when interpreting this data:
- Care should be taken when using this data to identify ‘avoidable GP type’ or ‘GP style’ presentations because it is based on urgency (triage) categories which may not reflect the various factors that influence the use of EDs such as the complexity of a presentation, the patient’s choice or condition, the most appropriate model of care for such presentations, or the accessibility and availability of primary and community health services.
- The NNAPEDCD is restricted to formal public EDs, and as such does not include all emergency or urgent care provided in Australian hospitals. In particular, this may affect comparability of results for regional and remote areas.
- Although there are national standards for data on non-admitted patient ED presentations, the way those presentations are defined and counted varies across states and territories, and over time, which may affect comparability across local areas.
Further information
For full details about the method, see the accompanying Technical notes.
Source:
AIHW analysis of the NNAPEDCD 2020–21; 2021–22.
Box 2: When is in-hours and after-hours for ED presentations?
In-hours includes weekdays from 8am to 8pm and Saturdays from 8am to 1pm (excluding public holidays).
After-hours includes Sundays, public holidays, weekdays before 8am and from 8pm, and Saturdays before 8am and from 1pm.
For further details refer to the Technical notes.
Impact of COVID-19 on emergency department activity
During the initial outbreak of COVID-19 in Australia, a range of restrictions on travel, business, social interaction and border control were introduced across most jurisdictions from February 2020 to prevent and reduce the spread of COVID‑19. In response to the ongoing COVID–19 pandemic, many restrictions have continued in some jurisdictions in 2020–21, and new restrictions put in place in 2021–22 in response to new variants of COVID-19. These restrictions have had effects on the delivery of emergency department care.
The specific factors that may have affected overall ED activity include:
- changes in patient behaviours, including changes in healthcare seeking behaviours and restricted activities that might reduce risks for some kinds of healthcare issues such as injuries or influenza
- patients being asked not to enter premises or re-directed to other services if they have symptoms consistent with COVID-19 or have been a close contact of someone who has been infected
- closure of, or restriction on, some types of healthcare services (for example, non-urgent surgery or dental care)
- establishment of testing facilities and fever clinics for COVID-19 – which, in some areas, may have been established as part of ED facilities
- establishment of new modes of delivery for healthcare services (for example, telehealth services funded through the Medicare Benefits Schedule) (AIHW 2023).
For more information about EDs, including the most common patient diagnoses and ED presentations by state and territory, see MyHospitals: Emergency department care.
References
AIHW (Australian Institute of Health and Welfare) 2023 Emergency department care activity, AIHW, Australian Government, accessed 21 February 2024.