Academic journal article Australian Health Review

Emergency Department Use in a Rural Australian Setting: Are the Factors Prompting Attendance Appropriate?

Academic journal article Australian Health Review

Emergency Department Use in a Rural Australian Setting: Are the Factors Prompting Attendance Appropriate?

Article excerpt


Increases in attendance rates at emergency departments (EDs) have prompted concerns regarding inappropriate utilisation. Factors instigating patient ED attendance were examined using a cross sectional survey of 522 patients presenting to the ED of a rural hospital in Australia, during a 1-week period. The results highlighted the importance of the rural hospital ED as an additional and alternate service to existing primary care facilities, particularly outside of business hours. The findings indicated that although patients' perception of an emergency does not necessarily correspond with clinical interpretations, the primary factors prompting attendance, including general practitioner unavailability, referrals and special service needs, suggest that, from a patients' perspective, the majority of presentations to the ED are justified.

Aust Health Rev 2008: 32(4): 710-719

ATTENDANCE RATES at emergency departments (EDs) throughout the world are steadily increasing1-6 creating a number of concerns for hospitals, including increased pressure on resources,1,7 and access block.3,4 Within Australia, the number of patients presenting to EDs in 2001-02 was about 5.7 million. This figure rose by 4.1% over a 3-year period, with over 5.9 million patients attending EDs in 2004-05.2

A number of studies cite "inappropriate" utilisation of the ED as one of the primary contributors to increasing attendance rates.3'6'7 However, the lack of a standardised definition of what is "inappropriate" ED utilisation impedes the ability to assimilate and assess previous findings. The different interpretations of inappropriate ED use significantly affect study results, and the classification of inappropriate visits can range from ten to ninety per cent.3 Similarly, New Zealand Health Technology Assessment8 reported that ED misuse ranged from three per cent to eighty per cent depending on the definition used by individual studies. The report confirmed that a valid and reliable method of defining appropriate ED utilisation had not been established and that clinicians, administrators and consumers had different opinions on what was considered appropriate.

Health administrators and emergency clinicians believe that primary care-type attendances are not appropriate in a hospital setting.9 However, as Bezzina and colleagues3 demonstrated, the definition of a primary care patient can vary from source to source. Contrary to the Australasian College for Emergency Medicine's (ACEM) line of thought that ED and general practice patient profiles differ greatly,10 the results of the National Health Strategy9 indicated that there was not always a clear distinction between primary care and ambulatory ED cases. Of the 15 950 patients surveyed during the study, 15.4% overlapped between ED-type patients and primary care patients. This overlap has also been recognised in other studies,3,11,12 illustrating that the categorisation of primary care-type patients as inappropriate within ambulatory care settings is not necessarily accurate.

The ACEM maintains "any individual with symptoms that lead them to believe that they have an injury or illness that could place their health in jeopardy, or lead to an impairment of their quality of life has the right to attend an emergency department".13 Although these guidelines seem straightforward, ED utilisation and the reason for patient attendance remains an issue of contention. Consequently, studies have attempted to identify why potential primary care patients choose to attend the ED as opposed to primary care services.

Recent figures largely attribute increasing ED attendance rates to a steady decline in bulk billing within general practice, believing that many ED attendees are general practice cases.5 It has been suggested that factors such as "consumer choice, free services, one stop shopping or the ageing population" represent reasons for the increasing demands on emergency services. …

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