Notes on the data: Emergency department presentations

Emergency department presentations, 2018/19

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]. Young children and people aged 65 years and over are over-represented among those accessing EDs, as are people who are homeless or transient.

The Australian Institute of Health and Wellbeing report that in 2018-19 there were 294 public hospitals that have purpose-built emergency departments which responded to 8.4 million presentations or 22,900 presentations each day. This has increased from an average of 20,200 presentations each day in 2014-15 an increase of 3.2% a year [2].

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 and over time [4]. 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 [4]). As a result, New South Wales had 60% 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 [4]. 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 286 hospitals with ED facilities. These facilities were geocoded from the listing reported by the Australian Institute of Health and Welfare [5].

Variation in the provision of Emergency Department services by Capital City and Rest of states/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 29% below the national rate in Hobart and 24% below in Melbourne to 55% above in Darwin;
for Urgent presentations, the range is from 31% below in Hobart to 26% above in Darwin;
for Semi-urgent presentations, the range is from 30% below in Brisbane and 24% below in Melbourne and to 84% above in Darwin; and
for Non-urgent presentations, from 50% below in Adelaide and 4% below in Hobart.

For Rest of states/ NT:

the range for Total presentations is from 21% below the national rate in Rest of SA to 269% above in Rest of NT;
for Urgent presentations, the range is from 34% below the national rate in Rest of SA to 244% above in Rest of NT;
for Semi-urgent presentations, the range is from 19% below in Rest of Qld to 272% above in Rest of NT; and
for Non-urgent presentations, from 51% below in Rest of Qld, to 309% above in Rest of NSW and 312% above in Rest of NT.

**Table 1: Variations in age-standardised rates, expressed as an index, of Emergency Department presentations, 2018/19 *(Australia = 100)*.**
Section of States	Total	Urgent	Semi-urgent	Non-urgent
Australia	100	100	100	100
All capital cities	86	91	83	64
Sydney	88	89	85	73
Melbourne	76	81	76	62
Brisbane	91	110	70	51
Adelaide	86	96	75	50
Perth	97	90	108	59
Hobart	71	69	72	96
Darwin	155	126	184	76
Canberra	99	112	96	92
Rest of NSW	160	128	181	309
Rest of Vic	106	99	115	120
Rest of Qld	94	112	81	49
Rest of SA	79	66	98	102
Rest of WA	167	137	193	268
Rest of Tas	117	106	144	123
Rest of NT	269	244	272	312

Emergency Department presentations by 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 2 shows the distribution of presentations by chapter and triage category. In this analysis of the 2018/19 ED data, we provide atlases for chapter and triage totals only. A total of 16 atlases were created from the numbers of presentations shown in bold. For analysis by chapter and triage category, please refer to the archived ED data for 2017/18 available here.

**Table 2: Emergency Department presentations by ICD-10-AM Chapter and Triage category for 2018/2019**
ICD-10-AM Chapter	Resuscitation within seconds	Emergency within 10 minute	Urgent within 30 minutes	Semi-urgent within 60 minutes	Non-urgent within 120 minutes	Grand Total
Certain infectious and parasitic diseases	1,662	38,971	171,145	171,561	15,353	398,692
Mental and behavioural disorders	3,040	46,088	148,680	83,747	19,152	300,707
Diseases of the circulatory system	14,788	144,898	127,704	45,518	5,557	338,465
Diseases of the respiratory system	8,165	133,108	299,764	179,892	15,864	636,793
Diseases of the digestive system	1,013	37,744	217,534	163,620	15,621	435,532
Diseases of the musculoskeletal system and connective tissue	336	19,794	119,369	237,378	43,497	420,374
Diseases of the genitourinary system	511	38,334	159,968	117,698	11,030	327,541
Injury, poisoning and certain other consequences of external causes	17,318	174,706	554,520	1,039,782	244,949	2,031,275
Factors influencing health status and contact with health services	945	13,057	50,330	90,579	101,919	256,830
Other	15,175	470,854	1,205,077	941,655	168,401	2,801,162
Total presentations	62,953	1,117,554	3,054,091	3,071,430	641,343	7,947,371

Emergency Department presentations by chapter, sex and age group

The Emergency Department presentation dataset for 2018/19 is disaggregated by ICD-10-AM chapter, sex and a range of selected age-groups, where the number of presentations was above 6,000. Tables 3, 4 and 5 show the distribution and number of records used to create a total of 147 atlases to highlight the geographic variation in the ICD-10-AM chapters by sex and selected age-groups across Australia.

**Table 3: Emergency Department presentations by ICD-10-AM Chapter, sex and selected age-group categories for 2018/2019.**
ICD-10-AM Chapter	Sex	0-14	15-24	25-44	45-64	65-74	75+
Total presentations	Males	929,840	460,150	891,099	814,458	384,170	485,926
Total presentations	Females	740,881	541,039	1,025,663	773,213	349,068	551,864
Total presentations	Persons	1,670,721	1,001,189	1,916,762	1,587,671	7,332,38	1,037,790
Certain infectious and parasitic diseases	Males	105,979	15,439	28,036	20,245	10,807	13,981
Certain infectious and parasitic diseases	Females	89,823	24,076	39,013	24,206	11,424	15,663
Certain infectious and parasitic diseases	Persons	195,802	39,515	67,049	44,451	22,231	29,644
Mental and behavioural disorders	Males	6,011	297,34	68,677	36,839	6,896	9,094
Mental and behavioural disorders	Females	7,393	35,759	51,265	30,922	6,676	11,441
Mental and behavioural disorders	Persons	13,404	65,493	119,942	67,761	13,572	20,535
Diseases of the digestive system	Persons	50,062	46,303	120,270	106,247	48,197	64,453
Diseases of the musculoskeletal system and connective tissue	Persons	46,732	45,621	110,794	114,577	46,987	55,663
Diseases of the genitourinary system	Males	15,539	8,638	25,857	31,825	17,003	21,882
Diseases of the genitourinary system	Females	16,839	38,784	77,423	34,507	14,238	25,006
Diseases of the genitourinary system	Persons	32,378	47,422	103,280	66,332	31,241	46,888
Injury, poisoning and certain other consequences of external causes	Males	309,218	207,063	293,375	193,491	67,082	78,203
Injury, poisoning and certain other consequences of external causes	Females	229,872	129,926	193,072	163,325	65,226	101,422
Injury, poisoning and certain other consequences of external causes	Persons	539,090	336,989	486,447	356,816	132,308	179,625
Factors influencing health status and contact with health services	Persons	43,466	35,069	72,550	54,269	22,014	29,462
Other diseases/ conditions	Persons	464,251	329,096	719,945	597,761	287,090	403,019

**Table 4: Emergency Department presentations by diseases of the circulatory system by sex for selected age-group categories for 2018/2019.**
ICD-10-AM Chapter	Sex	0-44	45-64	65-74	75+
Diseases of the circulatory system	Males	27,601	55,613	40,831	54,541
Diseases of the circulatory system	Females	26,225	39,718	31,921	62,015
Diseases of the circulatory system	Persons	53,826	95,331	72,752	116,556

**Table 5: Emergency Department presentations by diseases of the respiratory system by sex for selected age-group categories for 2018/2019.**
ICD-10-AM Chapter	Sex	0-4	5-14	15-24	25-44	45-64	65-74	75+
Diseases of the respiratory system	Males	122,820	40,864	19,282	33,482	37,761	28,522	46,382
Diseases of the respiratory system	Females	82,597	30,281	28,563	45,985	46,365	28,324	45,563
Diseases of the respiratory system	Persons	205,417	71,147	47,845	79,467	84,126	56,846	91,945

Detailed information on the Emergency Department dataset

The data include presentations to EDs between 1 July 2018 and 30 June 2019. 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 [4].

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:

A00–B99 (Certain infectious and parasitic diseases)
F00–F99 (Mental and behavioural disorders)
I00–I99 (Diseases of the circulatory system)
J00–J99 (Diseases of the respiratory system)
K00–K93 (Diseases of the digestive system)
M00–M99 (Diseases of the musculoskeletal system and connective tissue)
N00–N99 (Diseases of the genitourinary system)
S00–T98 (Injury, poisoning and certain other consequences of external causes)
Z00–Z99 (Factors influencing health status and contact with health services).
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

Ford G. The role of the Emergency Department as a 'safety net'. Health Issues 2002;73:29-32.
Australian Institute of Health and Welfare (AIHW). Australia's hospitals at a glance 2018-19. Canberra: AIHW; 2020.
Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2011-12. Health services series no. 50. (Cat. no. HSE 134.) Canberra: AIHW; 2013.
Australian Institute of Health and Welfare (AIHW). Emergency department care 2018–19: Appendices; 2020. https://www.aihw.gov.au/getmedia/8af27189-a1bb-4746-a096-e63d3b8aeac6/Emergency-department-care-201819-Appendixes.pdf.aspx (Accessed 15/06/2021).
Australian Institute of Health and Welfare (AIHW). Emergency department care. Canberra: AIHW; 2021. https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care (Accessed 15/06/2021).

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, Quintile of socioeconomic disadvantage of area and Remoteness Area

Numerator: Presentations to Emergency Departments by Totals, ICD-10-AM Chapter, Triage, and ICD-10-AM Chapter by sex and selected age-group categories (where available).

Denominator: Male, Female and Total populations where applicable.

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 2018/19; and ABS Estimated Resident Population, average of 30 June 2018 and 2019.