Key concepts

Mental health-related services in emergency departments

Key concept Description

Emergency department (ED) presentation

Emergency department (ED) presentation refers to the period of treatment or care between when a patient presents at an emergency department and when that person is recorded as having physically departed the emergency department. It includes presentations for patients who do not wait for treatment once registered or triaged in the emergency department, those who are dead on arrival, and those who are subsequently admitted to hospital or to beds or units in the emergency department. An individual may have multiple presentations in a year. Further information can be found in the Non-admitted emergency department care NMDS 2017–18.

Episode end status The episode end status indicates the status of the patient at the end of the non-admitted patient emergency department service episode. Further details on episode end status codes are available from the AIHW the Metadata Online Registry (METeOR).

Mental health‑related emergency department (ED)presentation

Mental health‑related emergency department (ED) presentation refers to an emergency department presentation that has a principal diagnosis that falls within the Mental and behavioural disorders chapter (Chapter 5) of ICD‑10‑AM (codes F00–F99) or the equivalent ICD‑9‑CM or SNOMED codes. It should be noted that this definition does not encompass all mental health‑related presentations to emergency departments, as detailed above. Additional information about this and applicable caveats can be found in the data source section.

Principal diagnosis

The principal diagnosis is the diagnosis established at the conclusion of the patient’s attendance in an emergency department to be mainly responsible for occasioning the attendance.

Triage

The triage category indicates the urgency of the patient’s need for medical and nursing care. It is usually assigned by an experienced registered nurse or medical practitioner at, or shortly after, the time of presentation to the emergency department. The triage category assigned is in response to the question: ‘This patient should wait for medical assessment and treatment no longer than...?’.

The Australasian Triage Scale has 5 categories that incorporate the time by which the patient should receive care:

• Resuscitation: immediate (within seconds)

• Emergency: within 10 minutes

• Urgent: within 30 minutes

• Semi-urgent: within 60 minutes

• Non-urgent: within 120 minutes.

Alternative text for mental health services provided in emergency department figures

Figure ED.1

Vertical bar chart showing the rate (per cent) of mental health-related emergency department presentations in public hospitals by state or territory in 2017–18. SA had the highest per cent of mental health-related ED presentations accounting for 4.8% of all ED presentations, followed by 4.4% in the NT, 4.2% in WA, 3.8% in Qld, 3.6% in Tas, 3.3% in NSW, 3.2% in Vic and 3.1% in the ACT. The national result was 3.6%. Refer to Table ED.1. Back to Figure ED.1

Figure ED.2

Horizontal bar chart showing the rate (per 10,000 population specific) of mental health-related emergency department presentations in public hospitals by patient demographics in 2017–18. Patients 18–24 years had the highest rate (per 10,000 age specific population) of mental health-related ED presentations at 197.0, followed by 85 years and over (174.1), 35–44 (165.8), 25–34 (159.3), 12–17 (143.4), 45–54 (133.0), 75–84 (93.8), 55–64 (78.9), 65–74 (59.6), 5–11 (16.9) and 0–4 (5.1). A higher rate of males (121.7) compared with females (110.0). A higher rate of Indigenous Australians (455.9) compared with non-Indigenous Australians (106.8). The rate tended to increase with increasing remoteness area; 101.3 per 10,000 in major cities, 130.3 inner regional, 129.3 outer regional and 203.6 remote and very remote areas. Mental health related presentations decreased with increasing socioeconomic quintile with 139.9 presentations per 10,000 for most disadvantaged quintile, to 76.3 for the least disadvantaged quintile. Refer to Table ED.7  Back to figure ED.2

Figure ED.3

Horizontal bar chart showing mental health-related emergency department presentations in public hospitals by principal diagnosis in 2017–18. The majority of mental health-related ED presentations were for mental and behavioural disorders due to psychoactive substance use (27.2%), and neurotic, stress-related and somatoform disorders (26.2%). Schizophrenia, schizotypal and delusional disorders made up 11.6% of presentations, Mood (affective) disorders 11.0%, mental disorder not otherwise specified 9.3%, organic, including symptomatic, mental disorders 8.0%, disorders of adult personality and behaviour 2.8%, behavioural and emotional disorders with onset usually occurring in childhood and adolescence 2.6%, behavioural syndromes associated with physiological disturbances and physical factors 1.1%, and disorders of psychological development 0.1%. Refer to Table ED.10 Back to figure ED.3

Figure ED.4

Pie chart showing mental health-related ED presentations in public hospitals by triage category. In 2017–18, 49.4% of mental health-related ED presentations were urgent, 29.3% semi-urgent, 14.4% emergency, 5.9% non-urgent, and 1.0% resuscitation. Refer to Table ED.5.  Back to figure ED.4

Figure ED.5

Chart presenting mental health-related ED presentation wait time (minutes) for 50th percentile (median) and 90th percentile of patients by State and Territory, 2017–18. Fifty per cent of patients waited up to 47 minutes in the Australian Capital Territory, 31 minutes in Tasmania, 30 minutes in Western Australia and South Australia, 27 minutes in the Northern Territory, 22 minutes in Queensland, 18 minutes in Victoria and 15 minutes in New South Wales. Across Australia 50% of patients waited up to 20 minutes. 90% of patients waited up to 169 minutes in the Australian Capital Territory, 152 minutes in South Australia, 144 minutes in Tasmania, 136 minutes in Western Australia, 131 minutes in the Northern Territory, 107 minutes in Queensland, 92 minutes in Victoria and 81 minutes in New South Wales. Across Australia 90% of patients waited up to 109 minutes. Refer to Table ED.9. Back to figure ED.5.

Figure ED.6

Chart presenting mental health-related ED presentations length of stay (minutes) for the median and 90th percentile patient­­­­­­­ by State and Territory, 2017–18. Fifty per cent of patients stayed in the ED for up to 4.8 hours in South Australia, 4.6 hours in Tasmania, 4.0 hours in the Australian Capital Territory, 3.8 hours in Victoria and Western Australia, 3.4 hours in the Northern Territory, 3.3 hours in Queensland, and 3.2 hours in New South Wales. Across Australia 50% of patients stayed up to 3.6 hours in the ED. Ninety per cent of patients who presented to ED with a mental and behavioural diagnosis stayed up to 20.9 hours in Tasmania, 17.0 hours in South Australia, 15.0 hours in Western Australia, 13.8 hours in Victoria, 13.6 hours in the Australian Capital Territory, 12.2 hours in the Northern Territory, 11.0 hours in New South Wales, and 9.3 hours in Queensland. Across Australia 90% of patients stayed up to 12.4 hours. Refer to Table ED.13. Back to figure ED.6