Notes on the data: Emergency department presentations

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]. 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.

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.

Notes:

The data include presentations to emergency departments (EDs) between 1 July 2019 and 30 June 2020. 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.

EDs (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.

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 ED 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.

Impact of COVID-19 on hospitalisations in 2019-20: The Australian Institute of Health and Welfare provides comment as to the impact of COVID-19 on presentations to public hospital EDs. For example, see https://www.aihw.gov.au/news-media/media-releases/2021-1/december/covid-19-continues-to-impact-public-hospital-emerg. We are unable to comment on the extent to which the pandemic has impacted differentially on rates of presentations across the geographic areas in the Atlas, including at the State and Territory level. However, a comparison of the whole-year data for Australia for 2018-19 and 2019-20 does not show any consistent differences when analysed by socioeconomic disadvantage of area, or Remoteness Area.

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).

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 Quintiles within PHNs, and Remoteness Area

Numerator: Presentations to emergency departments by 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 2019/20; and ABS Estimated Resident Population, average of 30 June 2019 and 2020.