Notes on the data: Emergency department presentations

Indigenous emergency department presentations, 2019/20

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 2018–19, about 7% of ED presentations (589,651) 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 [5]. 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 [5].

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 [5]. 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 [5]).

As a result, New South Wales had 62% of the nation’s public hospitals with ED services in 2017/18, 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 public acute hospitals [5]. 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 2, The variation in the provision of Emergency Department services by capital city and rest of state/territory to Indigenous people, below).

In addition, there is also considerable variation in access to ED services 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 2017/18 locations of the 286 hospitals with ED facilities. These facilities were geocoded from the listing reported by the Australian Institute of Health and Welfare [5]. In 2018/19, Western Australia commenced reporting for 6 Public acute group C hospitals in Western Australia [6]. It should be noted that while every effort is made by the government agencies to incorporate cross state/territory border movements of patients in the dataset, some data anomalies do occur since the reported location is based on a persons' area of residence.

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 2018–19: Australian hospital statistics. Supplementary data tables. Canberra: AIHW; 2019.
4. Australian Institute of Health and Welfare (AIHW). Access to primary health care relative to need for Indigenous Australians. Cat. no. AIHW 128. Canberra: AIHW; 2014
5. 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
6. Australian Institute of Health and Welfare (AIHW). Emergency department care 2018–19: Australian hospital statistics. Appendix A. Canberra: AIHW; 2019.

Confidentiality of data: Counts of 1 to 4 presentations have been suppressed.

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

Geography: Data available by Indigenous Area, Primary Health Network, Quintile of socioeconomic outcomes (based on IRSEO) and Remoteness Area

Numerator:  Presentations by Aboriginal people to Emergency Departments for above categories.

Denominator:  Estimated resident Aboriginal population, average of PHIDU-estimated populations, June 2019 and 2020.

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. A standardised ratio (SR) provides a comparison to the Australian rate which is assigned a value of 100. Ratios below 100 are proportionally less than the national rate, while ratios above 100 are proportionally higher than the national rate. The SR is the ratio of the observed value to the expected value (the expected value is age-standardised).

Data source of denominator population:  There is a substantial difference between the Census counts of Aboriginal and Torres Strait Islander Australians and the estimated resident population (ERP), adjusted for net undercount as measured by the Post Enumeration Survey undertaken by the ABS (the ERP is 17.5% higher for Australia than the Census count). Given this large difference, and as the ABS has not released Aboriginal ERP by age at the Indigenous Area level as used in the Social Health Atlases, PHIDU has calculated an estimated resident population for 30 June 2019 and 2020, for the calculation of rates. Further detail can be obtained by contacting PHIDU.

Data source:  Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2019/20 and estimated resident population, as calculated by PHIDU.

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