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 coronavirus (COVID‑19).

In the period July 2020 to the end of June 2021, many restrictions have continued to apply, though these have been applied differently across jurisdictions and at different times.

A number of changes to provision of healthcare services, may have impacted on ED activity 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 and fever clinics 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 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 ED activity over the 2018–19, 2019–20 and 2020–21 reporting periods, including:

• average daily presentations (by week) by
  • state and territory
  • 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.

With the initial outbreak of COVID-19 in 2019–20, the number of ED presentations decreased by 1.4% compared to 2018–19.

Between 2019–20 and 2020–21, however, ED presentations increased 6.9% compared to 2019–20.

ED presentations decreased in 2019–20 and returned to expected levels in 2020–21

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.

From July 2020:

• nationally, average daily presentations to emergency departments continued to increase, surpassing presentations in the same period in 2019–20 from the week commencing 28 October 2020
• for the week commencing 23 June 2021, average daily presentations were 25,721 compared to 21,365 in 2020 and 22,313 in 2019
• in Victoria, presentations to emergency departments continued to decrease from the week commencing 1 July 2020 to the week commencing 19 August as Victoria experienced an increase in COVID-19 cases between June and September 2020, and associated restrictions.

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 most weeks between July 2019 and February 2020, Non-urgent ED presentations accounted for 7–8% of ED presentations.
• In the week commencing 2 March 2020, 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 initial COVID‑19 outbreak.

This pattern continued in 2020–21, where non-urgent presentations continued to show the greatest variation. Over this period, non-urgent presentations accounted for between 8% and 15% of presentations.

Types of 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 2021:

• 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.
• presentations continued to increase in early 2020–21 with average daily presentations with a principal diagnosis of COVID‑19 (including emergency use codes U07.1, U07.2 and U06.0) rising to 898 in the week beginning on 29 July 2020 then decreasing to 244 in the week commencing 30 September 2020.
• 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. Respiratory presentations increased over the 2020–21 period fluctuated between 1,471 and 2,299, increasing to 2,541 in the week commencing 22 June 2021.
• 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 2020 to 2,400 presentations in the week beginning on 9 March 2020. 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.
• From July 2020, the Infectious presentations fluctuated, with sharp increases in presentations occurring across the 2020–21 year corresponding to increases in activity in a number of jurisdictions that may correspond to increased use of a diagnosis of viral illness, unspecified.

The average daily number of presentations with a diagnosis related to Injury decreased from 5,800 in the week beginning 24 February 2020 to 3,400 in the week beginning 30 March 2020. In 2020–21, the number of Injury related presentations followed a similar pattern to 2018–19 with average daily presentations varying between 4,900 to 6,200 across the year.

The decrease in the number of Injury related presentations during the early months of 2020 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. These restrictions were subsequently eased in many jurisdictions after July 2020.

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 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 commences at the point of being registered clinically or triaged.

Explore the data

Explore the number of presentations to Australia’s public hospital EDs between 2016–17 and 2020–21 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) (where data is available)
• hospital (where data is available).

Highlights

• There were 8,808,357 presentations to Australian emergency departments in 2020–21.
• Most presentations to emergency departments occurred in Principal referral and women’s and children’s and Public acute group A hospitals (72%).
• On average, emergency department presentations have increased 3.2% per year since 2016–17.

Age and sex

• ED presentations were generally evenly split between males and females. However, for those aged 0–14, substantially more were boys (55%) than girls (45%) in 2020–21.
• The highest presentation rate per 1,000 population (crude rate) was for patients aged over 85,1649 per 1,000 population)
• The second highest presentation rate per 1,000 population (crude rate) was for patients aged 4 and under (1,140 per 1,000 population).

Indigenous status

• About 7.5% of ED presentations (616,000) were for Aboriginal and Torres Strait Islander people, who represent about 3.4% of the Australian population.
• In all jurisdictions, and across all age groups, the presentation rate per 1,000 population was greater for Indigenous Australians compared to 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—298 presentations per 1,000 people.
• People living in Remote and Very remote areas (who make up 2% of the population) accounted for 3.5% of presentations.

Socioeconomic status of area of usual residence

• People living in the second lowest (second most disadvantaged) areas accounted for 23% of ED presentations—392 presentations per 1,000 people.
• People living in the highest (least disadvantaged) areas were the least likely to visit an ED. They accounted for 15% of all ED presentations—260 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. This indicates the urgency of the patient’s need for medical and nursing care.

In 2020–21 there were 8.8 million ED presentations, and of these:

• 0.8% were assigned a triage category of Resuscitation
• 14% were assigned to Emergency
• 37% were assigned to Urgent
• 37% were assigned to Semi-urgent
• 10% were assigned to Non-urgent.

Principal diagnosis

In 2020–21:

• Principal diagnoses classified to the ICD-10-AM chapter Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified accounted for 24% of  presentations (2.1 million presentations). These include cases for which no more specific or precise diagnosis could be made. Just under half of these presentations were assigned a triage category of Urgent (47%).
• The next most common ICD-10-AM principal diagnosis chapter reported was Injury, poisoning and certain other consequences of external causes, which accounted for a further 24% of presentations. Just over half of these presentations were assigned a triage category of Semi-urgent (51%).
• The 20 most common 3-character ICD-10-AM principal diagnoses accounted for 34% of principal diagnoses reported. The most common 3-character ICD-10-AM principal diagnoses were Abdominal and pelvic pain (4.7%), followed by Pain in throat and chest (4.4%), both diagnoses from the Symptoms, signs and abnormal clinical and laboratory findings chapter.

Arrival mode

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

In 2020–21:

• the majority of presentations to EDs (73%) 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.
• patients with a triage category of Resuscitation were most likely to have an arrival mode of Ambulance, air ambulance or helicopter rescue service (84%). 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 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 2020–21:

• 29% of all presentations were Admitted to this hospital at the conclusion of treatment in the ED. This proportion varied across states and territories (from 24 to 36%)
• 65% of patients aged 85 and over were Admitted to this hospital compared with 16% of patients aged 0–24
• 62% 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, 14% of Resuscitation patients Departed without being admitted or referred, compared with 87% of Non-urgent patients
• 2.3% of patients left the emergency department at their own risk (that is, after being attended by a health care professional but before the service episode was completed).