Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018

Lower, Tony; Kinsman, Leigh; Dinh, Michael; Lyle, David; Cheney, Richard; Allan, Julaine; Munro, A.; Taylor, Brian K.; Wiggers, John; Bailey, Andrew; L, Weller; Jacob, Alycia; Stephens, Alexandre

doi:10.1111/ajr.12668

Cited by 6 publications

(16 citation statements)

References 14 publications

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“…A relatively small number of emergency patients might expose limited bed capacity and a need for tertiary services makes transfer of patients to metropolitan centres more likely. Our study supports recent findings that there are high rates of IHT of critically unwell regional patients 7 and builds on ED information on the demographics of critically unwell patients 8 beyond the ED doors in a regional hospital.…”

Section: Discussionsupporting

confidence: 89%

“…Modelling based on NSW emergency presentations suggests there is likely to be an increase in complexity and acuity in both rural and metropolitan areas. These will particularly impact resourcing in regional and remote Australia where the number of disadvantaged Australians is already disproportionately greater 8 …”

Section: Discussionmentioning

confidence: 99%

“…Regional and rural Australians have poorer health than their urban counterparts, and they have less access to and are less likely to seek medical services 7 . With the ageing population, the increasing popularity of independent and extended travel (the so‐called ‘grey nomad’ phenomenon), the documented increases in emergency department (ED) presentations of elderly patients with acute conditions 8 and the stress that regional and rural hospitals already experience, 9 it is important to consider what impact tourism is having on rural and remote critical care resources.…”

Section: Introductionmentioning

confidence: 99%

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Critical care resource use associated with tourism in Central Australia

Robson

McAnulty

Secombe

2021

Australian J Rural Health

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Objective Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population. Design Single‐centre retrospective study using prospectively collected data from January 2009 to December 2018. Setting Australian regional intensive care unit. Participants All critical care admissions for patients aged over 18 years for whom postcode data were available were included. Outcome measures Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis. Results Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2 years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity. Conclusion Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Critical care resource use associated with tourism in Central Australia

Robson

McAnulty

Secombe

2021

Australian J Rural Health

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“…5 Studies on this subject primarily originate from countries with low population density or a higher degree of rural population, and information from European settings are scarce. 6–9 A Scottish study reported more multimorbidity in patients from urban areas than rural areas. 10 Age, comorbidity, discharge diagnosis, income, education and employment status, cohabitation, and polypharmacy are associated with mortality or readmission, and we hypothesized that they might vary across different degrees of urbanization.…”

Section: Introductionmentioning

confidence: 99%

Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark

Gregersen¹,

Maule²,

Bak-Jensen³

et al. 2022

CLEP

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Purpose To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]). Conclusion Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.

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“…Therefore, doctors require a broad skillset in rural settings to manage a diverse range of presentations and complications 5,6 . Despite low‐volume presentations, it has been demonstrated that rural EDs manage close to the same diverse range of critically ill patients as those seen in metropolitan EDs, and perform most of the same procedures 7,8 . The difficulty in maintaining adequate care when managing these patients in a rural environment is the combination of low‐volume presentations in association with their high‐acuity nature 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries

Kerr

Kealy

Lim

et al. 2021

Australian J Rural Health

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Objective Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high‐acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. Design and setting A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. Results Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. Discussion A typology was developed to account for (a) emergency department staff on‐floor, (b) emergency department staff on‐call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. Conclusion The proposed five‐tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy‐makers who are seeking to improve health systems and health outcomes.

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Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018

Cited by 6 publications

References 14 publications

Critical care resource use associated with tourism in Central Australia

Critical care resource use associated with tourism in Central Australia

Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark

Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries

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