Access block in Australian emergency departments 2017–2020

Abstract

Objective To describe Australian ED workload over the period 2017–2020 using data from twice annual Access Block Point Prevalence Studies, and to identify any impact of the COVID‐19 pandemic. Methods Retrospective analysis of demand and occupancy data provided by the Australasian College for Emergency Medicine accredited EDs in voluntary surveys at the start of June and September 2017–2020. Hospitals answering all surveys were grouped and compared by jurisdiction and role delineation. Results A total of 121 EDs were eligible, 63% supplied complete occupancy data and 53% complete demand data. Between the June 2017 and 2019 surveys, mean daily ED presentations increased by 11.4% (P = 0.0003). The number being treated at 10.00 hours rose by 27.7% (P < 0.0001) and those experiencing access block (waiting for an inpatient bed, been in ED more than 8 h) rose by 46.1% (P = 0.001). Between the June 2019 and 2020 surveys, ED presentations fell by an average of 12.6% (P < 0.0001), ward admissions were almost unchanged (−6.0%, P = NS), and patients who did not wait to be seen fell by 57.8% (P < 0.0001). Major Paediatric Referral hospitals reported a 28% decrease in presentations. By September 2020, only the state of Victoria (ongoing state of emergency) and Major Paediatric Referral hospitals reported demand lower than 2019 or occupancy lower than 2018. Conclusions Occupancy increased by more than demand 2017–2019, with some decrease in 2020: in June presentations were 12.7% lower than 2019, in September back to the normal range outside Victorian and Major Paediatric Referral hospitals. Future research needs to consider locality, role delineation and work practice change in comparing ED pandemic responses.

Defining emergency medicine

“…4,5 Despite this, EDs are often occupied by a significant number of patients who do not meet this definition. 5,6 There are instances where injury or illness turns out to be minor following emergency assessment and these presentations to ED are entirely warranted. However, patients with existing conditions, known to hospital services, with predictable, but unplanned requirements for care may not be best served by presentation to the ED.…”

“…The function of emergency medicine is to service ‘acute’, ‘urgent’, ‘unforeseen’ and ‘undifferentiated’ illness and injury 4,5 . Despite this, EDs are often occupied by a significant number of patients who do not meet this definition 5,6 . There are instances where injury or illness turns out to be minor following emergency assessment and these presentations to ED are entirely warranted.…”

Preparing for reopening: An emergency care perspective

“…The emergency care system has been under increasing strain for decades with escalating access block and overcrowding, even before the pandemic 3,4 . Ambulance ramping, waiting times and ED length of stay have been worsening across Australia because of inexorable increases in attendances and disease complexity 5 .…”

“…The true numbers will be higher than those reported, because the simulations in the Doherty Institute modelling only extend to 6 months post reopening. Furthermore, the Doherty report focuses on the outcomes of mechanical ventilation in ICU and deaths; it does not model the predicted demand on the emergency care system, namely EDs and ambulance services, and the complications that may result 3 …”

Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED‐1)

“…A persistent increase in ED attendances above population growth 1 has contributed to overcrowded EDs, limiting capacity to provide optimal emergency care for consumers. The pandemic has exacerbated pressure with staff shortages, ward closures, disruption to community services and isolation and infection control procedures 2,3 …”