Emergency department care activity

During the initial outbreak of COVID-19 in Australia, a range of restrictions on travel, business, social interaction and border control 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 have continued in some jurisdictions in 2020–21, and new restrictions put in place in 2021–22 in response to new variants of COVID-19. These restrictions have had effects on the delivery of emergency department care.

The specific factors that may have impacted 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 others services if they have symptoms consistent with COVID-19 or have been a close contact of someone who has been infected
• closure of, or restriction on, some types healthcare services (e.g. 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; and
• establishment of new modes of delivery for healthcare services (e.g. telehealth services funded through the Medicare Benefits Schedule).

This section presents analyses on presentations to emergency departments (EDs) in Australia during this period to explore the impact of these changes.

Explore the data

The data visualisations below allow users to explore the changes in emergency department activity from 2018–19 to 2022–23, including

Average daily presentations (by month) by

• state and territory
• triage category
• disease/body system groupings, including COVID-19.

Highlights

• ED presentations between 2021–22 and 2022–23, remained relatively stable, increasing by 0.1%. They were also stable between 2020–21 and 2021–22 decreasing by 0.2%
• between 2019–20 and 2020–21, ED presentations increased by 6.9%, representing a rebound following low growth in the early stages of the pandemic
• with the initial outbreak of COVID-19 in 2019–20, the number of ED presentations decreased by 1.4% compared to 2018–19
• in the years preceding COVID-19, between 2014–15 and 2018–19, the number of presentations to public hospital EDs increased by 3.2% on average each year.

Impact of COVID-19 on overall ED activity

The average daily ED presentations in 2022–23 was stable with no month showing a drastically high or low number of presentations. The lowest number of average daily presentations was in July 2022 (22,938 presentations) and the highest was in March 2023 (24,780 presentations), a difference of 1,842.

This stability is similar to the pre-pandemic year of 2018–19, where the lowest number of average daily presentations was 21,609 in July 2018 and the highest was 23,520 in March 2019, a difference of 1,911.

In the intervening years, average daily presentations to ED changed due to COVID-19 waves, mutations and associated lockdowns.

In 2021–22, they dropped twice. 

• Between June 2021 and September 2021, the average daily ED presentations dropped from 25,000 to 23,200.
• Following this, the average daily ED presentations increased to a peak of 26,000 in December 2021 dropping to 22,500 in February 2022.

In 2020–21, average daily presentations to ED increased steadily from 21,400 in July 2020 to 25,100 in June 2021 which was higher than the corresponding period in 2018–19 for all months except July 2020 and September 2020. Despite this return to pre COVID-19 ED activity at a national level, ED presentations in Victoria decreased from July to August 2020, potentially due to an increase of local COVID-19 cases between June and September 2020, and associated restrictions.

Prior to the outbreak of COVID-19 in Australia, the average daily presentations to emergency departments steadily increased from 21,600 in July 2018 to 23,900 in February 2020, an average increase of 0.54% per month. In March 2020, the average daily presentations to ED was 23,000 which then dropped to 17,000 in April 2020, a substantial decrease of 26% in a single month. The average daily ED presentations then steadily increased to 19,100 in May 2020 and 21,500 in June 2020, which was still 8.6% lower than the corresponding period in 2018–19. 

An ED presentation occurs following the arrival of the patient at the ED and commences at the point of being registered or triaged. Triage is the process during which a health professional assesses the urgency of the care needs, including assigning one of five urgency categories to the health record.

Explore the data

Explore the number of presentations to Australia’s public hospital EDs in 2022–23 and for recent years in the data visualisation below.

Information is presented by the following patient characteristics:

• age and sex (as recorded in the data)
• Indigenous status
• the remoteness of the patient's residential address
• the socioeconomic status of the area that the patient lives in.

The data can also be explored by:

• state and territory
• hospital peer group
• local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2022–23:

• there were 8.80 million presentations to emergency departments in Australia – a rate of 334 per 1,000 population
• most ED presentations were to Principal referral and women’s and children’s and Public acute group A hospitals (71%, combined).

Emergency presentations have increased over the last five years, from 8.35 million in 2018–19 to 8.80 million in 2022–23, representing an average annual increase of 1.3% per year. However the number of presentations fluctuated during the years that were affected by COVID, decreasing in 2019–20, increasing in 2020–21 and decreasing again 2021–22.

Presentations to Public acute group C hospitals have increased the most (3.9% per year since 2018–19).

Age and sex

• In 2022–23, while, overall, males accounted for 49% of all ED presentations and females accounted for 51%, there were differences across age groups. In age groups under 15 years, a higher proportion of presentations were for males, but for age groups between 15 to 44 years and 85 years and over, most presentations were for females. In the age groups between 45 and 84 years, presentations were more evenly split between males and females. 
• For both males and females, the highest rates of presentation per 1,000 population were for patients aged 85 or over – 941presentations per 1,000 population for males, and 764 per 1,000 population for females.
• The second highest presentation rates for both males and females were seen in  patients aged 4 and under – who presented at EDs at a rate of 707 per 1,000 population for males and 592 per 1,000 population for females. 
• While ED presentation rates were highest in the very young and very old age groups, 44% of all ED presentations were for people aged between 25 and 64. 

Indigenous status

• Overall, 8.4% of ED presentations were for Aboriginal and Torres Strait Islander (First Nations) people (who make up 3.8% of the Australian population).
• Across all age groups, the presentation rates per 1,000 population were greater for First Nations people compared to Other Australians. The largest difference was for people aged 40–44 where the presentation rate was 980 per 1,000 population for First Nations people and 256 per 1,000 population for Other Australians.  

Remoteness area of usual residence 

• People living in Major cities (who make up 72% of the Australian population), accounted for 62% of ED presentations – 294 presentations per 1,000 people. 
• People living in Remote and Very remote areas (who make up 1.9% of the population) accounted for 3.6% of presentations.
• Information on presentation rates should be interpreted with caution as the scope of the ED data collection is ‘formal’ EDs that meet specific criteria and may not be evenly accessible to people across all geographic areas. 

Socioeconomic status of area of usual residence

• People living in the lowest socioeconomic (most disadvantaged) areas were most likely to visit an ED, accounting for 24% of ED presentations (410 presentations per 1,000 people). This was followed by people who lived in areas classified as being in the second lowest socioeconomic position – who presented at a rate of 386 presentations per 1,000 population. 
• People living in the highest socioeconomic (least disadvantaged) areas were least likely to visit an ED. They accounted for 14% of all ED presentations (233 presentations per 1,000 people).

• Patients present to the emergency department (ED) for various reasons. This section presents information on care provided in EDs by:
• urgency of care
• mode of arrival
• reason for care (principal diagnosis)
• how care was completed.

Explore the data

In the data visualisation below you can explore ED presentations by ICD-10-AM principal diagnosis chapter, age group and sex.

Highlights

Urgency of care

When a patient presents to the ED, a registered nurse or medical practitioner assigns them a triage category. The triage category indicates the time within which their clinical care should commence and hence the urgency of the patient’s need for medical and nursing care.

In2022–23, there were 8.8 million ED presentations, and of these:

• 0.9% were assigned a triage category of Resuscitation
• 16% were assigned as Emergency
• 40% were assigned as Urgent
• 36% were assigned as Semi-urgent
• 6.8% were assigned as Non-urgent.

Principal diagnosis

In one-quarter of all presentations (26%) no specific condition is diagnosed. This may reflect a focus in EDs on managing the symptoms and immediate care needs of patients, which often does not require (or allow time for) detailed examination and assessment of the underlying causes and conditions. 

In 2022–23, where a principal diagnosis was provided, the most common principal diagnosis group was the Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified ICD-10-AM group, which accounted for 26% of presentations (2.3 million presentations). Almost half (47%) of these presentations were assigned a triage category of urgent. In 2018–19 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified accounted for 23% (1.9 million presentations).  

The next most common group was Injury, poisoning and certain other consequences of external causes, which accounted for 22% of presentations (2.0 million presentations). Almost half (49%) of these presentations were assigned a triage category of semi-urgent. In 2018–19, Injury, poisoning and certain other consequences of external causes accounted for 25% (2.1 million presentations). 

Arrival mode

The mode of arrival relates to how a patient arrives at the ED, whether by ambulance, or another form of transport. 

In 2022–23, around three-quarters (73%) of people presenting to EDs arrive by private  transport (categorised as Other); the remainder arrived by ambulance or rescue services. Patients with a triage category of Resuscitation were most likely to have an arrival mode of Ambulance, air ambulance or helicopter rescue service (83%). This arrival mode becomes less likely as the urgency of care decreases.

How care was completed

The episode end status describes the status of the patient at the conclusion of their episode in the emergency department, including whether the patient was subsequently admitted to the hospital. 

Most ED presentations end with the patient leaving the hospital. A smaller proportion of patients are admitted to the hospital however, this varies considerably across jurisdictions and can reflect differing admission practices (i.e. where one hospital might admit a patient overnight, another may manage their care entirely within the ED).

 In 2022–23:

• 29% of all presentations to ED ended in hospital admission. This proportion varied across states and territories from 24% in New South Wales to 37% in Australian Capital Territory 
• 52% of patients aged 65 and over who presented to ED were Admitted to this hospital
• 63% of patients aged 85 and over were Admitted to this hospital compared with 16% of patients aged 0–24
• 60% of all presentations reported an episode end status of Departed without being admitted or referred. This proportion was higher for less urgent triage categories – for example, 15% of Resuscitation patients Departed without being admitted or referred, compared with 78% of Non-urgent patients. 
• 3.5% of patients (309,000) left the emergency department at their own risk, with 44% of these patients being categorised as Urgent, 11% as Emergency, and 0.3% as Resuscitation.