‘Lower urgency’ ED presentations can’t be blamed for crowding

The Australasian College for Emergency Medicine (ACEM) cautions against placing too much weight on ‘GP type’ patients presenting to hospital emergency departments (EDs) as the main cause of ED crowding.

This follows the release of Australian Institute of Health and Welfare data on ‘lower urgency’ emergency department presentations which ACEM is concerned paints an overly simplistic picture.

“It is a popular but misguided public narrative that ‘GP-type’ patients are the main cause of crowding and therefore access block in EDs,” said ACEM President Dr John Bonning. “In reality, patients with relatively minor ailments who present to EDs generally do not require beds or admission to hospital. Attributing the dangerous crowding and access block which occurs in EDs to such patients risks distracting from the systemic and deep-rooted causes of such issues.”

The most serious driver of overcrowding is access block which occurs when a patient, who has received their initial care and stabilisation in an ED from emergency medical staff, and needs to be admitted to hospital for ongoing medical care, is unable to go to a ward and must stay in the ED. These patients are often left waiting in corridors and/or blocking treatment spaces, taking up ED staff resources and preventing new patients coming in to commence their care. This can also lead to having to keep patients in ambulances (sometimes with dire consequences) due to a lack of physical space in EDs.

“Crowding and access block is overwhelmingly caused by the inability to admit seriously ill or injured patients from the ED to beds in the hospital or more definitive care, due to combination of hospital capacity or systemic issues. We know that this type of crowding is dangerous not just to patients stuck in the ED but to all patients who arrive at the ED. It is these issues which must be the priority in fixing ED crowding,” said Dr Bonning.

“Of course aiming to keep people out of hospital via preventative measures or early healthcare intervention is what we should all be aiming for. However, assuming we only need to stop people coming to hospitals and get them to see GPs is an overly simplistic solution, and suggesting that triage 4 and 5 patients or those not admitted to hospital are unnecessary ED presentations is disingenuous.

“GPs have a crucial role, but whole of healthcare system solutions are also needed to ensure people have access to additional accessible, affordable and appropriate options, so they don’t feel the ED is their only choice. Such options must also be available well outside of office hours, seven days a week. This applies not just to GP-type patients, but to those experiencing mental health crises, needing other specialist care, or whose needs could be better met elsewhere within systems. We also need to know much more about why patients are coming to the ED, as they are making rational decisions about the availability of services in their area.

“There are many lessons to be learned from the response to COVID-19, and initiatives such as virtual healthcare models and extended access to specialists and clinics are also part of solutions. It is only by taking a holistic approach, including by improving patient flow and discharge arrangements in our hospitals, that we will address complex issue of ED crowding.”

Background

ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au

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