NSW Emergency Department Records for Epidemiology (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Public unplanned emergency department (ED) presentations are included from 84 NSW hospitals that reported continuously and collected reasonably complete diagnosis information since 2009-10.
Presentations to the 84 NSW EDs included in this report accounted for approximately 87% of all NSW public hospital ED activity (planned and unplanned) 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 presentations that were not pre-arranged, with the majority classified as emergency presentations.
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.
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 conditions 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).
||SNOMED Concepts which map to specified ICD 10 classifications (as provided by the then National e-Health Transition Authority, now the National Clinical Terminology Service https://www.healthterminologies.gov.au/ operated by the Australian Digital Health Agency)
Unplanned emergency department presentations only are included.
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
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