Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations.

OBJECTIVE: EDs are an essential service, and higher rates of presentations per population are seen in regional and remote areas compared to major cities. Australia-wide differences in utilisation and performance remain largely unknown. METHODS: This was a descriptive, retrospective epidemiological study analysing data collected via the National Non-Admitted Patient Emergency Department Care Database managed by the Australian Institute of Health and Welfare. Data from all reporting public hospitals in Australia for the period between 1 July 2018 and 30 June 2019 were analysed. Reporting EDs were geographically categorised using the 2016 Australian Statistical Geography Standard - Remoteness Area. RESULTS: ED presentations for the 293 reporting EDs were 8 352 192 (median 17 904, range 8-113 929), one-third (33.09%, 95% CI 33.06-33.12) were outside major cities. Remote ED presentations were less likely to arrive by ambulance (12.13% [12.01-12.26]; major cites 28.07% [28.03-28.10]; regional 22.55% [22.50-22.60]) but more likely by police/correctional services vehicle (major cities 0.59% [0.58-0.60]; regional 0.71% [0.70-0.72]; remote 1.71% [1.66-1.76]). Presentations to remote EDs were more likely to leave without being attended by a health professional (5.29% [5.21-5.38]; major cities 3.93% [3.92-3.95]; regional 3.53% [3.51-3.55]). A larger proportion of admitted patients stayed at least 8 h in remote (21.83% [21.46-22.20]) and regional (21.52% [21.41-21.62]) EDs compared to major cities (19.82% [19.76-19.88]). CONCLUSIONS: Our study highlights ED utilisation, casemix and performance by location. The differences observed, especially areas of inequity and need for interventions, reiterate that imperative regional and remote EDs are appropriately resourced to support the communities they serve.

Where are children seen in Australian emergency departments? Implications for research efforts.

OBJECTIVE: With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs. METHODS: Retrospective epidemiological study assessing paediatric case-mix and time-based performance metrics (aged 0-14 years) obtained from a national health service minimum dataset for the 2017-2018 financial year, comparing tertiary paediatric EDs and all other EDs. We defined a 'major tertiary paediatric hospital' as one which was accredited for training in both paediatric emergency medicine and paediatric intensive care. RESULTS: Of the 1 695 854 paediatric ED presentations, 23.8% were seen in nine major metropolitan tertiary paediatric hospitals. Reasons for presentations were more distinctive between cohorts among children aged 10-14 years, where psychiatric illness (5.2% vs 2.5%) and neurological illness (4.5% vs 2.5%) were more commonly seen in major tertiary paediatric EDs. Australian Indigenous children were significantly less likely to present to tertiary paediatric EDs (3.0%), compared with other EDs (9.7%) (odds ratio 0.27, 95% confidence interval 0.26-0.27). While median waiting times were longer in major tertiary paediatric EDs (28 min [interquartile range 11-65]) than in other EDs (20 min [interquartile range 8-48], P < 0.001), patients were also less likely to leave without being seen (5.5% in tertiary paediatric EDs vs 6.9% in other EDs; odds ratio 0.80, 95% confidence interval 0.78-0.81). CONCLUSIONS: The present study identified key areas of difference in paediatric presentations between tertiary paediatric EDs and other EDs. It is vital to broaden paediatric ED research beyond tertiary paediatric centres, to ensure relevance and generalisability.

Characteristics of Aboriginal and Torres Strait Islander peoples attending Australian emergency departments.

OBJECTIVE: Aboriginal and Torres Strait Islander patients are overrepresented in Australian EDs. The present study aimed to assess their characteristics in utilising ED services at a national level. METHODS: This exploratory, quantitative study used 2016-2017 de-identified data from the National Non-admitted Patient Emergency Department Care Database to assess the proportions (with 95% confidence interval) of Indigenous and non-Indigenous Australians across various aspects of ED presentations, including mode of arrival, triage scale, diagnosis information, episode end status and ED length of stay. Episode level ED data were compared by Indigenous status and geographical remoteness of EDs. RESULTS: Of 7.4 million presentations, 6.58% were Indigenous presentations, with over two-thirds occurring in regional and remote EDs. Indigenous patients were more likely than non-Indigenous patients to arrive to EDs by ambulance and police/correctional services vehicle across all remoteness areas. Additionally, they were more likely to present with respiratory system illness, illness of the skin/subcutaneous tissue/breast and mental/behavioural disorders. Indigenous Australians were more likely to leave EDs before being seen or care complete (odds ratio 1.73, 95% confidence interval 1.71-1.74), and this was observed for patients classified across all levels of triage scale. CONCLUSIONS: This is the first national study looking at the characteristics of and reasons for presenting to Australian EDs for Indigenous and non-Indigenous patients. Our findings provide important insight into the potential factors affecting Indigenous patient care, and an impetus for ongoing research and advocacy work to improve the quality of emergency care provided to Indigenous Australians.

New Fellows Early Career Survey 2014-2017: Shift of trends in emergency medicine workforce.

OBJECTIVE: Within the complex and dynamic emergency medicine workforce setting, the Australasian College for Emergency Medicine (ACEM) New Fellows (FACEMs) Early Career Survey was established in 2014 to capture information on the work profiles, future career plans and challenges experienced among new FACEMs. METHODS: The voluntary online survey is distributed twice yearly to new FACEMs who gained their Fellowship the preceding 6-12 months. Eligible new FACEMs were contacted by email and invited to participate. RESULTS: A representative sample of 348 (53%) of 660 eligible new FACEMs responded to the survey from 2014 to 2017. New Fellows in the 2017 cohort were less likely to have secured a specialist position at attainment of Fellowship or 6-12 months later. Compared with new FACEMs in earlier cohorts, they were significantly more likely to be working in regional areas, across multiple workplaces and in more than one area of clinical/professional practice. The proportion of new FACEMs working part-time or in casual positions (42%) remained reasonably consistent across the 4 years. Finding a specialist position and securing a permanent position were among the main challenges experienced by new FACEMs after attaining their Fellowship. CONCLUSION: A shift in the employment profile of early career Fellows was observed between 2014 and 2017, with the potential push factor of limited specialist positions in metropolitan areas now starting to result in an increase in new FACEMs choosing to work in regional and rural areas and in the number working across multiple workplaces.