National Emergency Department patient presentations drop during COVID-19

The impact of COVID-19 restrictions in Australia has caused a reduction in Emergency Department (ED) hospital presentations in 2019-2020.

The Australian Institute of Health and Welfare (AIHW) data shows 8.2 million patients presented to Emergency Departments in 2019-2020, a 1.4% drop compared to 2018-2019.

The AIHW said the introduction of restrictions, between February and June last year, on travel, business, social interaction, and border control to reduce the spread of COVID-19, caused the recent decrease in ED presentations.

Factors that effected ED activity during this period included the closure of healthcare providers, patients with COVID-19 symptoms being asked not to enter premises or re-directed to other services, facilities being used for coronavirus testing and patients using the Medicare Benefits Schedule telehealth scheme.

In Australia, an ED presentation occurs when a patient arrives at a hospital and begins at the point of being triaged; an assessment by a medical practitioner who determines what type of care the patient requires.

Triage categories are defined by the urgency of patient care and divided into the areas of Resuscitation; requiring treatment within seconds, Emergency; requiring treatment within 10 minutes, Urgent; requiring treatment within 30 minutes, Semi-urgent; requiring treatment within 60 minutes and Non-urgent; requiring treatment within 120 minutes.

Time measurement in an ED is documented in 5 stages, presentation time is the first contact with a clinician when the patient is triaged, and a health professional commences care, the non-admitted patient records an episode procedure end time, and the physical departure time completes the ED activity.

The AIHW said the national rate of ED presentations had increased at an average rate of 3.2% each year from 2014-2015 to 2018-2019 before the 1.4% drop this year due to COVID-19.

An analysis of the ED triage category data by percentage of patients seen on time in the year 2014-2015 and 2019-2020 shows a decrease of 4% in Emergency, 2% in Semi-urgent, 1% in Non-urgent, and only a 1% increase in the Urgent category, with the Resuscitation category remaining steady at 100% of patients treated.

The AIHW data shows the national median waiting time in an ED was quicker with 17 minutes median waiting time in 2019-2020 and 74% patients seen on time, compared to 19 minutes in 2015-2016 and 73% patients seen on time.

The median length of an ED presentation for all patients increased by 15 minutes from two hours and 41 minutes in 2014-2015 compared to two hours and 56 minutes in 2019-2020.

The overall length of ED stays increased by 36 minutes, with 90% of all patient presentations taking seven hours and 30 minutes in 2019-2020 compared with six hours and 54 minutes in 2015-2016.

There has been a 3.9% drop nationally in the proportion of care completed within four hours with 69.2% departing the ED within four hours of arrival in 2019-2020 compared to 73.1% of patients treated in 2015-2016.

Patients who had the most presentations to EDs recently in 2019-2020 were children under four years and patients over 75 years.

The most common principal diagnosis of ED presentations in the AIHW 2019 -2020 data were patients with an injury or poisoning, patients that showed unusual symptoms and signs consistent with abnormal laboratory findings, diseases of the respiratory system and digestive system, musculoskeletal issues, and infectious diseases.

Of all ED presentations by triage category during this time, the most patients, 38.6% required Urgent treatment, followed by 38.1% in the Semi-urgent category, 14.2% classified as an Emergency, 8.2% were Non-urgent, with only 0.8% needing Resuscitation.

The proportion of presentations allocated a triage category of Urgent increased between 2015-2016 and 2019-2020, and the proportions assigned a category of Semi-urgent and Non-urgent decreased.

A patient often arrives at an ED by ambulance or another transport mode, during 2019-2020 most ED presentations, 72%, arrived in the mode of Other, which suggests the patient walked, came by private, public or community transport or taxi.

Generally, ED presentations were evenly divided between males and females, although children were most likely male under 15 and people aged 15 to 34 and over 85 tended to be female.

Of all presentations 31% were admitted to hospital at the end status of the patient’s episode in the ED, with 66% of these patients over 85 years and 17% aged under 24 being admitted to hospital, and 61% of all presentations recorded an end status of departed without being admitted or referred during 2019-2020.

Particularly, in early March this year daily average ED presentations increased from 24,600 to 26,000, by the middle of March they had dropped by 38%, and then began to steadily increase in June, although still 8.4% lower than the previous year.

The AIHW projected that without COVID-19 the average daily ED presentations would have remained consistent at an average of 23,000 per day.

Check the Emergency Department care section of the AIHW website for specific information.