Emergency department care activity

During the initial outbreak of COVID-19 in Australia, a range of restrictions on travel, business, social interaction and border control were introduced across most jurisdictions from February 2020 to prevent and reduce the spread of COVID‑19. In response to the ongoing COVID–19 pandemic, many restrictions have continued in some jurisdictions in 2020–21, and new restrictions put in place in 2021–22 in response to new variants of COVID-19. These restrictions have had effects on the delivery of emergency department care.

The specific factors that may have impacted overall ED activity include:

• changes in patient behaviours, including changes in healthcare seeking behaviours and restricted activities that might reduce risks for some kinds of healthcare issues such as injuries or influenza
• patients being asked not to enter premises or re-directed to others services if they have symptoms consistent with COVID-19 or have been a close contact of someone who has been infected
• closure of, or restriction on, some types healthcare services (e.g. non-urgent surgery or dental care)
• establishment of testing facilities and fever clinics for COVID-19 – which, in some areas, may have been established as part of ED facilities; and
• establishment of new modes of delivery for healthcare services (e.g. telehealth services funded through the Medicare Benefits Schedule).

This section presents analyses on presentations to emergency departments (EDs) in Australia during this period to explore the impact of these changes.

Explore the data

The data visualisations below allow users to explore the changes in emergency department activity from 2018–19 to 2021–22.

• average daily presentations (by month) by
  • state and territory
  • triage category
  • disease/body system groupings, including COVID-19.

Highlights

• ED presentations between 2020–21 and 2021–22, remained relatively stable, decreasing by 0.2% overall.
• In the previous year, between 2019–20 and 2020–21, ED presentations increased by 6.9%, representing a rebound following low growth in the early stages of the pandemic.
• With the initial outbreak of COVID-19 in 2019–20, the number of ED presentations decreased by 1.4% compared to 2018–19.
• In the years preceding COVID-19, between 2014–15 and 2018–19, the number of presentations to public hospital EDs increased by 3.2% on average each year. 

Impact of COVID-19 on overall ED activity

In 2021–22, average daily presentations to ED dropped twice due to COVID-19 waves, mutations and associated lockdowns.

• Between June 2021 and September 2021, the average daily ED presentations dropped from 25,000 to 23,200.
• Following this, the average daily ED presentations increased to a peak of 26,000 in December 2021 dropping to 22,500 in February 2022, which was lower than the corresponding period in 2018–19.

From February 2022, the average daily presentations to ED increased steadily to 24,300 in June 2022.

In 2020–21, average daily presentations to ED increased steadily from 21,400 in July 2020 to 25,100 in June 2021 which was higher than the corresponding period in 2018–19 for all months except July 2020 and September 2020. Despite this return to pre COVID-19 ED activity at a national level, ED presentations in Victoria decreased from July to August 2020, potentially due to an increase of local COVID-19 cases between June and September 2020, and associated restrictions.

Prior to the outbreak of COVID-19 in Australia, the average daily presentations to emergency departments steadily increased from 21,600 in July 2018 to 23,900 in February 2020, an average increase of 0.56% per month. In March 2020, the average daily presentations to ED were 23,000 which then dropped to 17,000 in April 2020, a substantial decrease of 26% in a single month. The average daily ED presentations then steadily increased to 19,100 in May 2020 and 21,500 in June 2020, which was still 8.6% lower than the corresponding period in 2018–19.

Urgency of care

When a patient presents to the ED an experienced registered nurse or medical practitioner allocates them a triage category. This indicates the urgency of the patient’s need for medical and nursing care.

During outbreaks of COVID-19, the proportion of ED presentations with chronic or minor symptoms and for whom treatment can be delayed up to 2 hours increased.

• In the early months of 2021–22, that is July 2021 to August 2021, the proportion of ED presentations that were assigned a triage category of Non-urgent ranged between 10% and 12%. Additionally, in December 2021, this proportion peaked to 13% which was then followed by a gradual decrease to 7% by June 2022.
• In 2020–21, variation was observed due to COVID-19 outbreaks and the associated lockdowns, where non-urgent presentations accounted for between 9% and 13% of presentations.

In the months between July 2019 and February 2020, the average daily Non-urgent presentations accounted for 7–8% of average daily ED presentations. In March 2020, Non-urgent presentations increased and accounted for 13% of the average daily number of ED presentations. Non-urgent ED presentations then declined to around 10–11% between April to June 2020.

COVID-19 changes the types of ED presentations

The outbreak of COVID‑19 infections and associated national and jurisdiction-based measures influenced the types of presentation to emergency departments in Australia from February 2020. 

Over the period from February 2020 to June 2022, the average daily presentations with a principal diagnosis of COVID-19 (including emergency use codes U07.1 and U07.2):

• continually rose from just 1 in February 2020 to 702 in August 2020, and then decreased to 263 in October 2020
• following another spike of 433 in December 2020, it fell to 135 in April 2021
• in 2021–22, average daily presentations with a COVID-19 diagnosis rose again to a peak of 739 in August 2021 and then fell to a low of 261 in November 2021
• the highest peak of 1,681 was seen in January 2022, followed by a sharp fall to 545 in February 2022, which increased again to 801 in April 2022 and then decreased to 469 in June 2022.

Over the period from February 2020 to June 2022:

• The average daily number of presentation with a diagnosis related to Injury decreased from 4,567 in February 2020 to 3,316 in April 2020. In 2021–22, the average daily presentation fell from 4,795 in December 2021 to 4,116 in January 2022
• The decrease in the number of Injury related presentations during the early months of 2020 and 2022 is likely influenced by the increased restrictions on public and social gatherings and activities, including sporting events and travel restrictions, and availability of other health facilities.
• The average daily number of presentations with a principal diagnosis in the Respiratory body system group increased from 2,055 in February 2020 to 2,881 in March 2020. Respiratory presentations decreased from 2,430 in June 2021 to a low of 1,326 in February 2022 (at a time when COVID-19 diagnoses peaked) and then rose 3,162 in June 2022.
• The average daily number of presentations with a principal diagnosis in the Infectious body system group rose sharply from 1,094 in February 2020 to 1,762 in March 2020. Presentations then dropped to 646 in May 2020, largely replaced by COVID-19 related presentations. This could be due to the use of the viral illness, unspecified code during this period.
• From July 2020, the Infectious presentations fluctuated, with sharp increases occurring in 2020–21 and 2021–22 that may relate to an increase in ED activity in a number of jurisdictions and again an increased use of the code viral illness, unspecified.

An ED presentation occurs following the arrival of the patient at the ED and commences at the point of being registered or triaged. Triage is the process during which a health professional assesses the urgency of the care needs, including assigning one of five urgency categories to the health record.

Explore the data

Explore the number of presentations to Australia’s public hospital EDs between 2017–18 and 2021–22 in the data visualisation below.

Information is presented by the following patient characteristics:

• age and sex (as recorded in the data)
• Indigenous status
• the remoteness of the patient's residential address
• the socioeconomic status of the area that the patient lives in.

The data can also be explored by:

• state and territory
• hospital peer group
• local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

Overall, in 2021–22:

• There were 8.79 million presentations to emergency departments in Australia – a rate of 339 per 1,000 population
• Most ED presentations were to Principal referral and women’s and children’s and Public acute group A hospitals (71%, combined).

Emergency presentations have increased over the last five years, from 8.01 million in 2017–18 to 8.79 million in 2021–22, representing an average annual increase of 2.3% per year. However the number of presentations fluctuated during the years that were affected by COVID, decreasing in 2019–20 and increasing again in 2020–21.

Presentations to Public acute group C hospitals have increased the most by 6.4% per year since 2017–18.

Age and sex

• In 2021–22, while, overall, males accounted for 49% of all ED presentations and females accounted for 51%, there were differences across age groups. In age groups under 15 years, a higher proportion of presentations were for males, but for age groups between 15 to 44 years and 85 years and over, most presentations were for females. In the age groups between 45 and 84 years, presentations were more evenly split between males and females.
• For both males and females, the highest rates of presentation per 1,000 population were for patients aged 85 or over – 873 presentations per 1,000 population for males, and 712 per 1,000 population for females.
• The second highest presentation rates for both males and females were seen in  patients aged 4 and under – who presented at EDs at a rate of 649 per 1,000 population for males and 548 per 1,000 population for females.
• While ED presentation rates were highest in the very young and very old age groups, 46% of all ED presentations were for people aged between 25 and 64.

Indigenous status

• Overall, 7.7% of ED presentations were for Aboriginal and Torres Strait Islander people.
• Across all age groups, the presentation rates per 1,000 population were greater for Indigenous Australians compared to Other Australians. The largest difference was for people aged 35–39 where the presentation rate was 967.1 per 1,000 population for Indigenous Australians and 279.5 per 1,000 population for Other Australians.

Remoteness area of usual residence 

• People living in Major cities (who make up 72% of the Australian population), accounted for 63% of ED presentations—297 presentations per 1,000 people.
• People living in Remote and Very remote areas (who make up 2.0% of the population) accounted for 3.4% of presentations.
• Information on presentation rates should be interpreted with caution as the scope of the ED data collection is ‘formal’ EDs that meet specific criteria and may not be evenly accessible to people across all geographic areas.

Socioeconomic status of area of usual residence

• People living in the second lowest socioeconomic (second most disadvantaged) areas were most likely to visit an ED, accounting for 23% of ED presentations (340 presentations per 1,000 people.) This was followed by people who lived in areas classified as being of lowest socioeconomic status – who presented at a rate of 378 presentations per 1,000 population.
• People living in the highest socioeconomic (least disadvantaged) areas were least likely to visit an ED. They accounted for 15% of all ED presentations (250 presentations per 1,000 people).

Patients present to the emergency department (ED) for various reasons. This section presents information on care provided in EDs by:

• urgency of care
• mode of arrival
• reason for care (principal diagnosis)
• how care was completed.

Explore the data

In the data visualisation below you can explore ED presentations by ICD-10-AM principal diagnosis chapter, age group and sex.

Highlights

Urgency of care

When a patient presents to the ED, a registered nurse or medical practitioner allocates them a triage category. The triage category indicates the time within which their clinical care must commence and hence the urgency of the patient’s need for medical and nursing care.

In 2021–22, there were 8.8 million ED presentations, and of these:

• 0.8% were assigned a triage category of Resuscitation
• 15% were assigned as Emergency
• 38% were assigned as Urgent
• 36% were assigned as Semi-urgent
• 9.3% were assigned as Non-urgent.

Principal diagnosis

In one-quarter of all presentations (25%) no specific condition is diagnosed. This may reflect a focus in EDs on managing the symptoms and immediate care needs of patients, which often does not require (or allow time for) detailed examination and assessment of the underlying causes and conditions.

In 2021–22, where a principal diagnosis was provided:

• The most common principal diagnosis group was the Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified ICD-10-AM group, which accounted for 25% of presentations (2.2 million presentations); in 2017–18 they accounted for 21% (1.6 million presentations). Just under half of these presentations were assigned a triage category of Urgent (46%).
• The next most common group was Injury, poisoning and certain other consequences of external causes, which accounted for 22% of presentations (1.9 million presentations); in 2017–18, they accounted for 25% (1.9 million presentations). Half of these presentations were assigned a triage category of semi-urgent (50%).

Arrival mode

The mode of arrival relates to how a patient arrives at the ED, whether by ambulance, or another form of transport.

In 2021–22:

• Around three-quarters of people presenting to EDs arrive by private transport (categorised as Other). The remainder arrived by ambulance or rescue services.
• Patients with a triage category of Resuscitation were most likely to have an arrival mode of Ambulance, air ambulance or helicopter rescue service (83%). This arrival mode becomes less likely as the urgency of care decreases.

How care was completed

The episode end status describes the status of the patient at the conclusion of the episode in the emergency department, including whether the patient was subsequently admitted to the hospital.

Most ED presentations end with the patient leaving the hospital. A smaller proportion of patients are admitted to the hospital, however, this varies considerably across jurisdictions and can reflect differing admission practices (ie. where one hospital might admit a patient overnight, another may manage their care entirely within the ED).

In 2021–22:

• 28% of all presentations to ED ended in hospital admission. This proportion varied across states and territories from 23% in New South Wales to 34% in Victoria.
• 52% of patients aged 65 and over who presented to ED were Admitted to this hospital.
• 64% of patients aged 85 and over were Admitted to this hospital compared with 15% of patients aged 0–24.
• 63% of all presentations reported an episode end status of Departed without being admitted or referred. This proportion was higher for less urgent triage categories – for example, 13% of Resuscitation patients Departed without being admitted or referred, compared with 85% of Non-urgent patients.
• 2.8% of patients (250,100) left the emergency department at their own risk, with 43% of these patients being categorised as Urgent, 11% as Emergency, and 0.3% as Resuscitation.