New insights into demand on emergency department services

New insights into demand on emergency department services

BHI is always working to deliver new insights into the performance of the NSW public healthcare system, including in our Healthcare Quarterly report series which tracks activity and performance for emergency department (ED), admitted patient, elective surgery and ambulance services.

In Healthcare Quarterly, we routinely report the number of patients who left the ED without, or before completing treatment. Since mid-2021, this number has been increasing, peaking at 76,117 in April to June 2022, up 67.6% compared with the same period in 2019, prior to the pandemic.

We identified that half (51.3%) of those patients were triaged as semi-urgent (triage category 4) with a further 13.1% in the least serious non-urgent (triage 5) category and 28.8% urgent (triage 3).

There will be many different reasons why people leave the ED without, or before completing treatment, and it is important to note that this measure includes patients who:

  • were triaged but left the ED before treatment began, and;
  • patients who began treatment but left before it was completed.

Emergency department attendances, by mode of leaving, NSW, April 2017 to June 2022

(The World Health Organisation declared the COVID-19 pandemic on 12 March 2022 and first restrictions were introduced in NSW on 16 March 2022)

To understand more about this measure, we did some further analysis of patients' journeys after they leave the ED. The analysis used five years of data up to March 2022, with data not yet being available for the April to June quarter.

This analysis, which is included in the latest issue of Healthcare Quarterly, reveals that around one in five patients who left without, or before completing treatment, tended to return to the same or a different ED within three days. If that was the case also in April to June, it would have resulted in perhaps 13,000 to 15,000 additional ED visits.

Percentage of patients who left without, or before completing, treatment who re-presented to any ED within three days, NSW, April 2017 to March 2022

This analysis of re-presentations provides just one indicator of the range of pressures on EDs, which have seen a general upward trend in total attendances over the past five years. This has included major fluctuations in activity since the beginning of the COVID-19 pandemic, a time when the system has also had to deal with pandemic restrictions, changes in the way care is delivered, forced staff absence due to illness and, more recently, the winter flu season.

This insight, alongside BHI's routine reporting, is designed to inform action by healthcare professionals and policy makers, and provide transparency for the community.

Healthcare Quarterly, April to June 2022 is available here.

Page updated: 13 Sep 2022