Emergency department care activity

Between February and the end of June 2020, a range of restrictions on travel, business, social interaction and border control were introduced to prevent and reduce the spread of coronavirus (COVID 19).

In this period, there have also been a number of other changes that may have impacted on the provision of healthcare services, including:

• 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 dental care)
• establishment of testing facilities for COVID-19
• establishment of new modes of delivery for healthcare services (e.g. telehealth services funded through the Medicare Benefits Schedule), and
• 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.

This section presents weekly analysis of presentations to emergency departments (EDs) over 2 years (2018–19 to 2019–20) to highlight the impact of these changes on ED activity and allow comparison between years.

Explore the data

The data visualisations below present data on ED presentations for 2019–20, including:

• average daily presentations (by week) by
  • triage category
  • disease/body system groupings, including suspected COVID-19.

• actual and projected ED presentations for 2019–20 (by month).

In some visualisations, data are also presented for 2018–19 for comparative purposes.

Highlights

Nationally, between 2014–15 and 2018–19 the number of presentations to public hospital EDs increased by 3.2% on average each year. However, in 2019–20, the number of ED presentations decreased by 1.4% compared to 2018–19.

ED presentations decreased

From March to June 2020:

• the average daily ED presentations initially increased from 24,600 in the week commencing 2 March 2020 to 26,000 average daily presentations in the week commencing 9 March 2020
• average daily presentations then decreased to 16,200 between the weeks commencing 9 March and the week commencing 30 March—a decrease of 38%

• the average daily ED presentations then steadily increased, though were still lower than in the comparable period in 2019. In the week beginning 22 June, there were, on average, 21,400 daily ED presentations—8.4% lower than for the comparable period in 2019.

Projected estimates of ED activity for 2019–20 suggest that, without the impact of COVID-19, the average daily number of ED presentations would have remained steady at around 23,000 presentations per day on average.

See Notes for information on how data on the projected presentations were calculated.

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.

In the period from March to June 2020, the proportion of ED presentations assigned a triage category of Non-urgent increased, as a proportion of the total presentations per week.

• In the weeks between  July 2019 and February 2020, Non-urgent ED presentations accounted for 7–8% of ED presentations.
• In the week commencing 2 March, Non-urgent ED presentations accounted for 9% of the weekly total of all ED presentations, which increased to 15% in the week commencing 16 March.
• Non-urgent ED presentations then declined to around 10–12% in April to June 2020. 

This suggests that the volume of ED presentations with chronic or minor symptoms and for whom treatment could be delayed up to 2 hours increased during the COVID‑19 outbreak.

As a proportion of all triage categories, other triage categories (Resuscitation, Emergency, and Urgent) remained stable across the time period, however there was a slight decline in Urgent and Semi-urgent ED presentations from March to June 2020.

Types of presentations

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

In the period from February to June 2020:

• the average daily presentations with a principal diagnosis of COVID 19 (including emergency use codes U07.1, U07.2 and U06.0) peaked at 785 in the week beginning on 23 March, and then fluctuated between 321 average daily presentations in the week beginning 6 April to 775 presentations on average per day in the week beginning 15 June.
• the average daily number of presentations with a principal diagnosis in the Respiratory body system group increased from 1,900 in the week beginning on 3 February to 3,500 in the week beginning on 9 March. The trend generally declined after this period.
• the average daily number of presentations with a principal diagnosis in the Infectious body system group rose sharply from 1,100 in the week beginning on 17 February to 2,400 presentations in the week beginning on 9 March. Presentations with this diagnosis declined to around 600 average daily presentations in the week of 20 February, largely being replaced by COVID-19 related presentations. This could be due to the use of the viral illness, unspecified code during this period.

The average daily number of presentations with a diagnosis related to Injury decreased from 5,800 in the week beginning 17 February and then declined to 3,400 in the week beginning on 30 March.

These trends are 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.

More information about the data

Principal diagnosis

The Emergency department ICD-10-AM (eleventh edition) Principal diagnosis short list was used to group Principal diagnosis into Disease/body system group. For more information, see METeOR.

Body system groupings

Presentations were grouped into Emergency department ICD-10-AM (10th edition) Principal Diagnosis Short list Disease/body system group based on the principal diagnosis at the 3-character level.

The visualisation showing body system groups in 2018–19 and 2019–20 includes only presentations assigned a principal diagnosis.

Exceptions to the use of IHPA body system group are:

• Injury—in which all body system groups with the ‘Injury’ prefix were grouped into a single Injury category.
• COVID-19—the two emergency codes used for COVID-19 (U06.0 and U07.1) have been extracted and placed into a separate ‘COVID-19’ category. 

Projected emergency department presentations

Projected emergency department presentations were calculated using the average daily emergency department presentations for each month over a six-year period from 2013–14 to 2018–19. 

The average change per year was then applied onto the 2018–19 data to create a projection for average daily emergency presentations for each month in
2019–20.

What other information is available on COVID-19?

To explore the influence of the COVID‑19 on other health data, further releases are available on the AIHW website under COVID‑19 Resources and The impact of COVID-19 on Australia's health system.

Information on the total confirmed cases and active cases can be found on the Australian Government Department of Health website.

What other information is available on emergency departments?

Data are also available on emergency department presentations by hospital or LHN in My local area.

Appendixes and caveat information for this data is available to download in the Info and downloads section.

Definitions of the terms used in this section are available in the Glossary.

An emergency department (ED) presentation occurs following the arrival of the patient at the ED, and commencesat the point of being registered or triaged.

Explore the data

Explore the number of presentations to Australia’s public hospital EDs between 2015–16 and 2019–20 in the data visualisation below.

Information is presented by: 

• age and sex
• Indigenous status.

The data can also be explored by:

• overall national trends
• state and territory
• Local Hospital Network (LHN) and hospital (where data is available).

National trends

Age and sex

• ED presentations were generally evenly split between males and females. However, children aged under 15 were more likely to be male , but people aged 15 to 34 or over 85 were more likely to be female.
• Patients aged 4 and under (who make up less than 7% of the population), accounted for 10% of all ED presentations.
• Patients aged 65 and over (who make up 16% of the population) accounted for 22% of all ED presentations in 2019–20.

Indigenous status

• About 7.5% of ED presentations (616,000) were for Aboriginal and Torres Strait Islander people (Indigenous Australians), who represent about 3.4% of the Australian population.
• In all jurisdictions, the presentation rate per 1,000 population was greater for Indigenous Australians compared to Other Australians.

Remoteness area of usual residence 

• 62% of ED presentations were for people living in Major cities—who make up 72% of the Australian population (281 presentations per 1,000 people).
• People living in Remote and Very remote areas (who make up 2% of the population) accounted for 4% of presentations.

Socioeconomic status of area of usual residence

• 23% of ED presentations were for patients living in areas classified as being the lowest (most disadvantaged) socioeconomic group (371 presentations per 1,000 people).
• The smallest number of presentations was reported for patients living in areas classified as being the highest (least disadvantaged) socioeconomic group (14% of the total) (235 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.

National trends

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.

In 2019–20 there were 8.2 million ED presentations, and of these:

• 0.8% were assigned a triage category of Resuscitation (requiring immediate treatment, within seconds)
• 14% were assigned to Emergency (requiring treatment within 10 minutes)
• 38% were assigned to Urgent  (requiring treatment within 30 minutes)
• 38% were assigned to Semi-urgent (requiring treatment within 60 minutes)
• 8.9% were assigned to Non-urgent  ​(requiring treatment within 120 minutes)

Between 2015–16 and 2019–20 the proportion of presentations assigned a triage category of Urgent increased, and the proportions assigned the triage categories of Semi-urgent or Non-urgent decreased.

For more information on triage category see the Glossary.

Principal diagnosis

In 2019–20:

• presentations with a a principal diagnosis of Injury, poisoning and certain other consequences of external causes accounted for approximately 1 in 4 presentations (1.9 million). These include fractures, burns, toxic effects of medicinal and non-medicinal substances drug overdoses (accidental or otherwise, legal or prescription)
• the 20 most common 3-character ICD-10-AM principal diagnoses accounted for 33% of principal diagnoses reported
• the most common 3-character ICD-10-AM principal diagnoses were Abdominal and pelvic pain (4.6%), followed by Pain in throat and chest (4.3%).

Arrival mode

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

In 2019–20, the majority of presentations to EDs (72%) had an arrival mode of Other which indicates that the patient either walked into the ED, or came by private transport, public transport, community transport, or taxi.

How care was completed

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

In the data visualisation, you can explore ED visits by type of presentation.

In 2019–20:

• 31% of all presentations were Admitted to this hospital at the conclusion of treatment in the ED and this proportion varied across states and territories (25–37%)
• 66% of patients aged 85 and over were Admitted to this hospital compared with 17% of patients aged 0–24
• 61% of all presentations reported an episode end status of Departed without being admitted or referred, and this proportion was higher for less urgent triage categories. For example, 13% of Resuscitation patients Departed without being admitted or referred, compared with 84% of Non-urgent patients.