RT Journal Article
SR Electronic
T1 Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e010964
DO 10.1136/bmjopen-2015-010964
VO 6
IS 5
A1 Michael M Dinh
A1 Saartje Berendsen Russell
A1 Kendall J Bein
A1 Dane R Chalkley
A1 David Muscatello
A1 Richard Paoloni
A1 Rebecca Ivers
YR 2016
UL http://bmjopen.bmj.com/content/6/5/e010964.abstract
AB Objective The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables.Design and setting This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes.Participants Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED.Results There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84).Conclusions Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.