Lower urgency care
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Summary How have rates of lower urgency care changed since 2017–18? Lower urgency emergency department presentations vary across geographical areas Rates of lower urgency presentations vary by socioeconomic areas and remoteness Rates of lower urgency presentations vary across Primary Health NetworksEmergency departments (EDs) are a vital part of Australia’s health care system; they provide care for people who require urgent, and often lifesaving, medical attention. People who attend EDs are managed according to the condition they are presenting with to ensure that the most urgent cases are dealt with most quickly. People are triaged into 1 of 5 categories on the Australasian Triage Scale. These vary on how soon people presenting to the ED need medical and/or nursing care. These categories are:
- Triage category 1 (Resuscitation): patient should be seen immediately (within seconds)
- Triage category 2 (Emergency): patient should be seen within 10 minutes
- Triage category 3 (Urgent): patient should be seen within 30 minutes
- Triage category 4 (Semi-urgent): patient should be seen within 60 minutes
- Triage category 5 (Non-urgent): patient should be seen within 120 minutes.
To ensure people receive the best care for their circumstances, there is a fundamental need to understand who uses emergency care services and the reasons why people may present to EDs instead of general practitioners.
This report explores a subset of ED presentations referred to as lower urgency care (Box 1) for the periods 2017–18 to 2022–23 based on performance indicator 19 as defined in the National Healthcare Agreement. Data are presented by remoteness areas, areas of socioeconomic disadvantage and Primary Health Networks. Data by Statistical Area Level 3 are also included in supplementary data tables.
Additional measures to understand the number of ED presentations per hour, arrivals by ambulance, and admissions to hospital by triage category have been included in the data tables to help inform services and initiatives.
This report does not provide insights into the impact of Medicare Urgent Care Clinics. These clinics began operating from 1 July 2023 with the aim of helping reduce pressure on hospital and emergency departments. For more information on Medicare Urgent Care Clinics, please see About Medicare Urgent Care Clinics | Australian Government Department of Health and Aged Care.
The data in this report are allocated geographically based on the 2021 Australian Statistical Geography Standard and 2023 Primary Health Network boundaries. Counts and rates in this report are not comparable to previous releases due to the change in boundaries, but are comparable across the years covered by this release.
Lower urgency ED presentations are defined as presentations at formal public hospital EDs where the person:
- had a type of visit to the ED of Emergency presentation
- had a triage category of semi-urgent (triage category 4: should be seen within 60 minutes) or non-urgent care (triage category 5: should be seen within 120 minutes)
- did not arrive by ambulance, or police or correctional vehicle
- was not admitted to the hospital, not referred to another hospital, and did not die.
These types of presentations are sometimes referred to as ‘avoidable GP type’ or ‘GP style’. However, there is nothing in the indicator specification that enables this kind of characterisation and so we do not present them as such. The indicator is based on the Australian College of Emergency Medicine’s Australasian Triage Scale for assessing emergency department patients. Further, more detailed work would need to be done, including looking at various factors that influence the most appropriate model of care for such presentations, including for example the complexity of a presentation and the patient’s choice or condition.
Why measure lower urgency ED presentations?
Understanding how and when people use emergency care services can inform decision-making, health care planning, and care coordination.
Lower urgency ED presentations are sometimes used as a proxy measure of access to primary health care because some patients presenting in these categories may be better managed elsewhere in the health system. However, this measure is based only on the categories of the Australasian Triage Scale, which reflects urgency and not the complexity or severity of a person’s health condition, nor does it identify the most appropriate and cost-efficient model of care for the patient or in that region.
It is important not to assume that all lower urgency ED presentations could be more appropriately or efficiently treated in another setting. For instance, someone who fractures their arm may be more appropriately treated at an ED that has access to diagnostic imaging tests not readily available in all other settings.
When is in-hours and after-hours for ED presentations?
In-hours includes weekdays from 8:00 am to 7:59 pm and Saturdays from 8:00 am to 12:59 pm (excluding public holidays).
After-hours includes Sundays, public holidays, weekdays before 8:00 am and from 8:00 pm, and Saturdays before 8:00 am and from 1:00 pm.
For further details refer to the technical notes.
How have rates of lower urgency care changed since 2017–18?
Around 1 in 3 ED presentations (33%, or 2.9 million) were classified as lower urgency in 2022–23. Age-standardised rates of lower urgency ED presentations decreased from about 120 per 1,000 people in 2017–18 to about 115 per 1,000 in 2019–20, peaked at about 130 per 1,000 in 2020–21, and then fell to about 115 per 1,000 in 2022–23 (Figure 1). The increase in rates of lower urgency presentations in 2020–21 coincided with the COVID-19 pandemic and was largely due to an increase in in-hours presentations. For more information on the impact of COVID-19 on ED presentations please see Box 2.
Figure 1: Age-standardised rates of lower urgency emergency department presentations, by presentation time, 2017–18 to 2022–23
| Period | All-hours | In-hours | After-hours |
|---|---|---|---|
| 2017–18 | 119.3 | 62 | 57.3 |
| 2018–19 | 120 | 62.8 | 57.3 |
| 2019–20 | 115.7 | 63.5 | 52.3 |
| 2020–21 | 127.8 | 72.3 | 55.6 |
| 2021–22 | 124.3 | 68.5 | 55.8 |
| 2022–23 | 114.3 | 61.9 | 52.4 |
- Lower urgency ED presentations are defined in accordance with National Healthcare Agreement: Performance Indicator 19-Selected potentially avoidable GP-type presentations to emergency departments, 2022.
- Rates are standardised to the 2001 Australian standard population.
Source:
AIHW analysis of the National Non-admitted Patient Emergency Department Care Dataset (NNAPEDCD) 2017–18 to 2022–23; Australian Bureau of Statistics (2024).
During the initial outbreak of COVID-19 in Australia, a range of restrictions on travel, business and social interaction, and border controls, 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 continued in some jurisdictions in 2020–21, and new restrictions were put in place in 2021–22 in response to new variants of COVID-19. These restrictions affected the delivery of emergency department care.
The specific factors that may have affected 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 other services if they have symptoms consistent with COVID-19 or had been a close contact of someone who had been infected
- closure of, or restrictions on, some types of healthcare services (for example, 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
- establishment of new modes of delivery for healthcare services (for example, telehealth services funded through the Medicare Benefits Schedule) (AIHW 2023).
For more information about EDs, including the most common patient diagnoses and ED presentations by state and territory, see Hospitals: Emergency department care.
Lower urgency emergency department presentations vary across geographical areas
This report describes results based on where people lived, not the location of the emergency department (ED). People can go to an ED outside their area.
Rates of lower urgency presentations vary by socioeconomic areas and remoteness
Since 2017–18, people living in areas of most socioeconomic disadvantage (Quintiles 1 and 2) had higher rates of lower urgency presentations than people living in areas of least disadvantage (Quintiles 4 and 5) (Figure 2).
Figure 2: Age-standardised rates of lower urgency emergency department presentations, by socioeconomic area, 2017–18 to 2022–23
| Period | 1 – lowest | 2 | 3 | 4 | 5 – highest |
|---|---|---|---|---|---|
| 2017–18 | 145.5 | 145.9 | 113.2 | 93.2 | 86.4 |
| 2018–19 | 149.6 | 149.3 | 111.6 | 93.5 | 85.9 |
| 2019–20 | 140.9 | 143.5 | 108.6 | 89.4 | 87.1 |
| 2020–21 | 145.3 | 156.3 | 121.6 | 102.6 | 106.4 |
| 2021–22 | 146.4 | 153.2 | 116.4 | 98.8 | 99.5 |
| 2022–23 | 143.3 | 146.2 | 105.1 | 86.6 | 81.9 |
- Lower urgency ED presentations are defined in accordance with National Healthcare Agreement: Performance Indicator 19-Selected potentially avoidable GP-type presentations to emergency departments, 2022.
- Rates are standardised to the 2001 Australian standard population.
- Socioeconomic area of usual residence is based on the patient’s area of usual residence (derived from Statistical Area Level 2 (SA2)), aggregated into quintiles (20%) by population as reported on Census Night 2021 according to the Index of Relative Socio-economic Disadvantage (ABS 2023c).
Source:
AIHW analysis of the National Non-admitted Patient Emergency Department Care Dataset (NNAPEDCD) 2017–18 to 2022–23; Australian Bureau of Statistics (2023c, 2024).
Rates of lower urgency ED presentations were consistently higher for people living in Remote and very remote areas than those living in other regions (Figure 3).
In 2022–23, people living in Remote and very remote Australia had 1.8 and 1.6 times the rates of lower urgency ED presentations than people living in Inner regional and Outer regional Australia, respectively, and 3.2 times the rates as people living in Major cities (Figure 3).
Figure 3: Age-standardised rates of lower urgency emergency department presentations, by remoteness area, 2017–18 to 2022–23
| Period | Major cities | Inner regional | Outer regional | Remote and very remote |
|---|---|---|---|---|
| 2017–18 | 96.9 | 169.2 | 164.4 | 228.5 |
| 2018–19 | 95.8 | 171.6 | 172.3 | 272.9 |
| 2019–20 | 92.5 | 164.8 | 165.4 | 277.5 |
| 2020–21 | 105.4 | 174.9 | 178.3 | 296.5 |
| 2021–22 | 102.4 | 167.8 | 176.7 | 280.8 |
| 2022–23 | 89.3 | 163 | 179 | 287.7 |
- Lower urgency ED presentations are defined in accordance with National Healthcare Agreement: Performance Indicator 19-Selected potentially avoidable GP-type presentations to emergency departments, 2022.
- Rates are standardised to the 2001 Australian standard population.
- Remoteness Areas of usual residence is based on the patient’s area of usual residence (derived from Statistical Area Level 2 (SA2)).
Source:
AIHW analysis of the National Non-admitted Patient Emergency Department Care Dataset (NNAPEDCD) 2017–18 to 2022–23; Australian Bureau of Statistics (2023b, 2024).
In line with higher rates of lower urgency presentations, self-reported data from the annual Australian Bureau of Statistics’ Patient Experiences Survey (2018, 2019, 2020, 2021, 2022, 2023a) found that between 2017–18 and 2022–23, people residing in Outer regional, Remote, and Very remote areas (30% in 2022–23) were consistently more likely than people living in Major cities (16% in 2022–23) to report that their main reason for visiting an ED instead of a general practitioner (GP) on their most recent occasion was because their GP was not available when required.
Rates of lower urgency presentations vary across Primary Health Networks
Since 2017–18, people living in regional Primary Health Network (PHN) areas had higher rates of lower urgency ED presentations than their metropolitan counterparts (Figure 4).
There was considerable variation across the individual PHNs. In 2022−23, Western NSW PHN had the highest age-standardised rate of 358 presentations per 1,000 people compared to the lowest of 50 per 1,000 in Darling Downs and West Moreton PHN (Qld).
For detailed data at the PHN and Statistical Area Level 3 (SA3) areas, refer to the data tab. For details about the geographical areas and groupings included in this report refer to the technical notes.
Figure 4: Age-standardised rates of lower urgency emergency department presentations, by Primary Health Network group, 2017–18 to 2022–23
| Period | Metropolitan | Regional |
|---|---|---|
| 2017–18 | 92.9 | 165.6 |
| 2018–19 | 91.8 | 171.2 |
| 2019–20 | 88.8 | 164.8 |
| 2020–21 | 101.7 | 176.7 |
| 2021–22 | 99.1 | 170.2 |
| 2022–23 | 85.4 | 167.1 |
- Lower urgency ED presentations are defined in accordance with National Healthcare Agreement: Performance Indicator 19-Selected potentially avoidable GP-type presentations to emergency departments, 2022.
- Rates are standardised to the 2001 Australian standard population.
- Primary Health Network is based on the patient’s area of usual residence (derived from Statistical Area Level 2 (SA2)). PHN areas with at least 85% of the population residing in Major cities were classified as metropolitan. PHN areas with less than 85% of the population residing in Major cities were classified as regional. For further details refer to the technical notes.
Source:
AIHW analysis of the National Non-admitted Patient Emergency Department Care Dataset (NNAPEDCD) 2017–18 to 2022–23; Australian Bureau of Statistics (2024); Department of Health and Aged Care (2024).
For more information about EDs, including the most common patient diagnoses and ED presentations by state and territory, see Hospitals: Emergency department care.
For more information about PHNs, including what they are, what they do and a map of their boundaries, see Primary Health Networks.
ABS (Australian Bureau of Statistics) (2018) Patient Experiences in Australia: Summary of Findings, 2017–18, ABS, Australian Government, accessed 13 December 2024.
ABS (2019) Patient Experiences in Australia: Summary of Findings, 2018–19, ABS, Australian Government, accessed 13 December 2024.
ABS (2020) Patient Experiences in Australia: Summary of Findings, 2019–20, ABS, Australian Government, accessed 13 December 2024.
ABS (2021) Patient Experiences in Australia: Summary of Findings, 2020–21, ABS, Australian Government, accessed 13 December 2024.
ABS (2022) Patient Experiences, 2021–22, ABS, Australian Government, accessed 13 December 2024.
ABS (2023a) Patient Experiences, 2022–23, ABS, Australian Government, accessed 13 December 2024.
ABS (2023b) Remoteness Areas – Australian Statistical Geography Standard (ASGS) Edition 3, ABS, Australian Government, accessed 13 December 2024.
ABS (2023c) Socio-Economic Indexes for Areas (SEIFA), Australia, ABS, Australian Government, accessed 13 December 2024.
ABS (2024) Regional population by age and sex, 2023, ABS, Australian Government, accessed 31 October 2024.
AIHW (Australian Institute of Health and Welfare) (2023) Emergency department care activity, AIHW, Australian Government, accessed 21 February 2024.
Department of Health and Aged Care (2024) Primary Health Networks, Department of Health and Aged Care, Australian Government, accessed 31 October 2024.