Growth in Western Australian emergency department demand during 2007-2013 is due to people with urgent and complex care needs (original) (raw)

2015, Emergency Medicine Australasia

To determine 1) the magnitude of the increase in Emergency Department (ED) demand in Western Australia (WA) from 2007-2013, and 2) whether primary care type patients seeking care in ED is the main reason for the increase. Methods We conducted a population-based longitudinal study examining trends in ED demand, stratified by area of residence, age group, sex, Australasian Triage Scale (ATS) category and discharge disposition. The outcome measures were annual number and rate of ED presentations. We calculated average annual growth, and agespecific and age-standardised rates. We assessed the statistical significance of trends, overall and within each category, using the Mann-Kendall trend test and ANOVA. We also calculated the proportions of growth in ED demand that were attributable to changes in population and utilisation rate. Results From 2007 to 2013, ED presentations increased by an average 4.6% annually from 739,742 to 945,244. The rate increased 1.4% from 354.1 to 382.6 per 1,000 WA population (p=0.02 for the seven-year trend). Most increase occurred in metropolitan WA, age 45+ yrs, ATS 2 and 3, and admitted cohorts. About three-quarters of this increase was due to population change (growth and ageing) and one-quarter due to increase in utilisation. Conclusion Our study reveals a 4.6% annual increase in ED demand in WA in 2007-2013, mostly due to an increase in people with urgent and complex care needs, and not a 'demand transfer' from primary care. This indicates that a system-wide integrated approach is required for demand management.