NSW Emergency Department Records for Epidemiology (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Alcohol problem emergency department (ED) presentations are selected using the following definition:
•Public unplanned ED presentations;
• To 84 NSW hospitals that reported continuously and collected reasonably complete diagnosis information since 2009-10;
• By persons aged 15 years and older;
• Where the provisional diagnosis was assigned an alcohol problem ICD-9, ICD-10 or SNOMED-CT code (as summarised in the Codes tab).
Presentations to the 84 NSW EDs included in this report accounted for approximately 87% of all NSW ED (planned and unplanned) activity in 2018-19. The data used to produce this report is subject to change from day to day due to data updates at the source ED
Unplanned presentations include those that were not pre-arranged, with the majority classified as emergency presentations.
This indicator is a direct measure of alcohol problem ED presentations (including acute intoxication and chronic alcohol problems). It is estimated that this indicator identifies about 24% of all alcohol-related ED presentations because many alcohol-related ED presentations are either coded as other problems (such as an injury), or patients leave before diagnosis and treatment occur (Indig et al 2008). In addition, a review of 1,000 presentations from this category found that 54% of presentations were for acute alcohol intoxication, 12% were for chronic alcohol problems where the person was intoxicated, 14% were for chronic alcohol problems and 21% could not be classified. Young persons (12 – 24 years) were more likely to present to ED with acute alcohol harm, with 82% of presentations within this age group classified as acute intoxication (Whitlam el al 2016).
Both the number of presentations and reported rates are under-estimated because not all emergency departments in NSW are included in the analysis. However, the trend over time includes a consistent cohort of hospitals and consistent population denominators and therefore allows for valid trend comparisons over the time.
Analyses by Local Health District, Primary Health Network, Local Government Area and remoteness from service centres are not included as the representation of EDs included in the analysis varies by geographic area. Rates were age-adjusted using the Australian population as at 30 June 2001. Age adjustment was used for analyses of all ages, but age-specific rates were not age-adjusted. Data refer to all presentations to the included EDs regardless of the district or state of residence of the patient.
Indig D, Copeland J, Conigrave KM, Rotenko I. Why are alcohol-related emergency department presentations under-detected? An exploratory study using nursing triage text. Drug Alcohol Rev 2008;27(6):584-90.
Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis-based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016 Nov;35(6):693-701
The NSW Emergency Department Records for Epidemiology (EDRE) is derived from computer databases used for managing patients in Emergency Departments (ED). It is an enhanced version of the NSW Emergency Department Data Collection (EDDC) and is accessed via SAPHaRI.
The EDDC commenced in 1994, but was organised into a formal data collection from July 1996. Only public hospital EDs participate in the EDDC. The number of participating EDs has increased over time from around 52 EDs in 1996-97 to around 177 EDs in 2018-19. The larger EDs participate in the EDDC so a substantial proportion of the NSW population is covered, but this proportion varies over time. Presentations to the 84 NSW hospital EDs included for reporting from EDRE accounted for approximately 87% of all NSW public ED activity in 2018-19.
Analyses based on ED diagnoses are useful for monitoring trends, but accuracy can vary due to the variation in computer programs used and data entry practices in each hospital. Unlike the admitted patient data collection, the EDDC does not have diagnoses formally coded by clinical coders. In EDs, the diagnoses are recorded by staff working in each emergency department. Depending on the computer program used in the hospital at a point in time, the diagnosis is recorded according to one of three classification systems – the International Classification of Disease Revision 9 (ICD-9), Revision 10 (ICD-10) or the Systematized Nomenclature of Medicine - Clinical Terminology (SNOMED-CT). ED diagnoses do not include intent or external cause codes.
Presentations are reported based on where a person presents to ED and not where a person resides, unlike the population denominator. Unplanned presentations include presentations that were not pre-arranged, with the majority classified as emergency presentations. Presentations may be reported by triage category and admission status. For more complete definitions, please refer to the Codes tab.
Depending on the information system used in the emergency department at a point in time, the diagnosis of acute alcohol problem is recorded according to one of three classification systems: the International Classification of Diseases, 9th revision (ICD-9), the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10) or the Systematised Nomenclature of Medicine — Clinical Terms (SNOMED-CT).
291, 303, 305, 305.0, 535.3, 790.3, 980, E860
F10, K29.2, R78.0, T51, X45, X65, Y15, Y90-Y91, Z50.2, Z71.4, Z72.1, Z86.41
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Codes: Presentations to emergency departments in NSW
|Emergency Department coding category||Code and description|
Unplanned ED presentations
Emergency department presentation type:
01 Emergency presentations
03 Unplanned return visit for a continuing condition
09 Person in transit
10 Dead on arrival
13 Current admitted patient
Mode of separation:
1 Admitted to ward or inpatient unit, not a critical care ward
3 Admitted: died in ED
10 Admitted: to a critical care ward
11 Admitted: via operating suite
12 Admitted: transferred to another hospital
1 Immediately life-threatening condition: need to have treatment immediately or within two minutes
2 Imminently life-threatening condition: need to have treatment within 10 minutes
3 Potentially life-threatening condition: need to have treatment within 30 minutes
4 Imminently serious condition: need to have treatment within one hour
5 Less urgent condition: need to have treatment within two hours
The 2019 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI) estimated that:
• 32.8% of adults (41.2% of men and 22.8% of women) consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol.
• 48.7% of Aboriginal adults consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol
• 26.7% of adults (34.7% of men and 19.1% of women) consumed more than 4 drinks on a single occasion in the previous four weeks.
Latest available data for secondary school students in NSW
• 13.7% of students aged 12-17 years (15.1% of boys and 12.3% of girls) consumed alcohol in the last 7 days as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
Self-reported data on consuming more than 2 standard alcoholic drinks on a day have been collected for adults in NSW since 1997 through the NSW Population Health Survey, and since 1985 through the National Drug Strategy Household Survey. Data from an interviewer-administered questionnaire has been collected in the ABS National Health Survey (2017-18).
Self-reported data on alcohol drinking in the past 7 days have been collected for students in NSW since 1987 through the NSW School Students Health Behaviours Survey.
Prevalence estimates, although differing slightly between surveys because of different sampling frames, participation rates and modes of collection (telephone versus self-completed questionnaires versus face-to-face personal interview versus drop-and-collect) have remained constant over time for adults and fallen in school students.
In 2018-19 in NSW:
• There were around 15,800 unplanned presentations to 84 NSW public hospital emergency departments for alcohol.
• The rate of ED presentations among persons aged 18-24 years (402.5 per 100,000 population) was around 1.6 times that of persons aged 15 years and over (254.5 per 100,000 population).
• The rate of ED presentations among males aged over 15 years was around 1.8 times that of females aged over 15 years, however similar between males and females aged 15-17 years (326.9 and 321.5 per 100,000 respectively).
• There were 10,129 presentations for alcohol-related problems among all males aged over 15 years and 1,532 in males aged 18-24 years (15% of total for males) compared with 5,673 for all females aged over 15 years and 1,423 for females aged 18-24 years (25% of total for females).
Data are from 84 NSW public hospital emergency departments (EDs) that have reported continuously since 2009-10 and have collected reasonably complete diagnosis information since 2009-10. These EDs accounted for around 87% of all emergency department activity in NSW in 2018-19, consequently the presentations reported here are under-estimates of the actual NSW presentations. The under-estimation differs by geographical area, which precludes analysis by Local Health District, Primary Health Network, Local Government Area and remoteness from service centres. Data refer to all presentations to the included EDs regardless of patients' district or state of residence.
A total of 45,005 hospitalisations were attributed to alcohol in NSW in 2018-19, which was approximately 1.5% of all hospitalisations.
The rate of hospitalisations attributable to alcohol has been relatively stable in all persons in recent years. There is a consistent pattern over time of increasing rates with increasing rurality and geographic remoteness. There is also a consistent pattern of higher rates in higher socioeconomic areas compared with more disadvantaged areas. The rate in the Aboriginal population was 1.8 times higher than the rate in the non-Aboriginal population in 2018-19.
There was considerable variation in the rate of hospitalisations attributable to alcohol between Local Government Areas (LGAs), with 21 LGAs having a rate significantly higher than the state average and 38 significantly lower than the state average (at the 1% level of significance) in the period 2015/16-2016/17.
Deaths attributable to alcohol
A total of 1,929 deaths were attributed to alcohol in NSW in 2018, which was approximately 3.6% of all deaths in 2018.
The death rate attributable to alcohol has shown a slight decrease in recent years. The rates in males and females were 26.6 and 13.2 deaths per 100,000 population respectively in 2018.
Australian Institute of Health and Welfare. National Drug Strategy Household Survey report. Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents
Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017-18. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/F6CE5715FE4AC1B1CA257AA30014C725?opendocument
Excessive alcohol consumption is one of the main preventable public health problems in Australia, with alcohol being second only to tobacco as a preventable cause of drug-related death and hospitalisation.
Long-term adverse effects of high consumption of alcohol on health include contribution to cardiovascular disease, some cancers, nutrition-related conditions, risks to unborn babies, cirrhosis of the liver, mental health conditions, tolerance and dependence, long term cognitive impairment, and self-harm.
The guidelines to reduce the health risks from drinking alcohol, published by the National Health and Medical Research Council in 2009, state that the lifetime risk of harm from alcohol-related disease or injury is reduced by drinking no more than two standard drinks on any day when drinking alcohol. These guidelines also state that drinking no more than four standard drinks on a single occasion reduces the immediate risk of alcohol-related injury arising from that occasion. In HealthStats NSW, the measure of lifetime risk of harm is defined as more than 2 standard drinks on a day when usually drinking, and is referred to as "long-term risk of harm" from alcohol consumption. As this definition is based on usual alcohol consumption, therefore representing an overall pattern of drinking, it reflects alcohol use related to health risk over the long-term.
Harm from alcohol-related accident or injury is experienced disproportionately by younger people; over half of all serious alcohol-related road injuries occur among 15–24-year-olds. However, harm from alcohol-related disease is more marked among older people.
National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. Available at: https://nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol
NSW Ministry of Health. Reducing alcohol-related harm snapshot
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au
NSW Health: Alcohol and other drugs website at http://www.health.nsw.gov.au/aod/Pages/default.aspx
Your Room website at http://yourroom.com.au/
Get Healthy Information and Coaching Service at http://www.gethealthynsw.com.au/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au
In NSW in 2018-19, there were over 2,555,000 unplanned presentations to 84 emergency departments participating in the Emergency Department Records for Epidemiology (EDRE) system.
Of the total unplanned emergency department presentations recorded in the EDRE in 2018-19, 9.6% (around 245,000) were in persons aged 80 years and over, and 12.6% (around 322,000) were in persons aged 15 to 24 years.
Children under the age of 15 years accounted for around 21.2% of all unplanned emergency department presentations in NSW in 2018-19, with those aged under 5 years accounting for around 11.4% of the total.
Emergency departments are places specialising in medical treatment of patients who present without a prior appointment and require care urgently. Emergency departments are equipped to deal with a very broad range of diseases and injuries, including life-threatening conditions. Emergency departments operate 24 hours a day. In NSW, they are attached to hospitals or multipurpose health services.
Emergency departments are also called accident and emergency (A&E), emergency rooms (ER) or casualty departments.
The term ‘presentation to emergency department’ refers to a visit by a person who requires medical care. Each visit is counted separately so the number of presentations may not be equal to the number of people seen or treated by the department.
At or soon after presentation, the patient is assigned a triage category which indicates the urgency with which they need to be assessed by a doctor or, in some cases, a nurse. The triage categories ranges from 1 to 5, with triage 1 being the most urgent and triage 5 the least urgent.
Sources of data on emergency department activity in NSW include the NSW Emergency Department Records for Epidemiology (EDRE) system based on the NSW Emergency Department Data Collection.
The NSW Ministry of Health reports emergency department information to the National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD).
These data are reported by many hospitals nationally, including all large hospitals and some small hospitals in NSW, and published by the National Health Performance Authority on their Myhospitals website.
In HealthStats NSW, emergency department information is reported from the EDRE. The information is reported by, for example, reason for presentation (diagnosis) and age of patients. These analyses assist in monitoring of public health concerns, for example outbreaks of communicable diseases.
In NSW, the Emergency Treatment Performance (ETP) has replaced the National Emergency Access Target (NEAT), and the expectation for ETP is that 81% of all patients presenting to a public hospital Emergency Department ED will, within 4 hours:
• physically leave the ED for admission to hospital;
• be referred to another hospital for treatment; or
• be discharged home.
The target does not overrule clinical judgement - it is recognised that it is sometimes clinically appropriate for patients to remain in the ED for more than 4 hours.
All ED patients are included in the target
In NSW, the organisation responsible for researching, planning and delivering more effective and efficient care in EDs is the Emergency Care Institute NSW (ECI). The ECI is a part of the Agency for Clinical Innovation (ACI), which is one of the ‘health pillars’ in NSW - supporting the NSW Ministry of Health in achieving better outcomes for all patients in NSW.
Readers can access the ECI website to learn more about current initiatives in coordination of care, networking and research in EDs, and an array of publications, including publications on tested models of care in EDs.
Health System Planning and Investment. Role delineation levels of emergency medicine. Sydney: NSW Ministry of Health, 2014. Available at: http://www.health.nsw.gov.au/services/Publications/role-delineation-levels.pdf
Emergency Care Institute NSW (ECI) at www.ecinsw.com.au
Bureau of Health Information at http://www.bhi.nsw.gov.au
Australian Institute of Health and Welfare. My hospitals. Available at www.myhospitals.gov.au