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.
© PHIDU, Torrens University Australia
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