1
|
Butler S, Tall J, Luscombe GM. Geographic variation in emergency department presentations among youth (10-24 years), New South Wales 2019: An epidemiological study. Emerg Med Australas 2023; 35:1013-1019. [PMID: 37468439 DOI: 10.1111/1742-6723.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To characterise ED presentations among youth in New South Wales (NSW) by geographic remoteness for 2019 and determine if intra-regional (inland vs coastal) variations exist. METHODS A population-based, retrospective descriptive analysis of 2019 Emergency Department Data Collection registry data for state-wide emergency presentations to NSW public hospitals among NSW residents aged 10-24 years was undertaken. Local government areas of residence were classified as major city, coastal regional, inland regional or remote. Sex and age-adjusted ED presentation rates were modelled according to geographical classification, using negative binomial regression. RESULTS In 2019, 178 public ED facilities in NSW received 479 880 presentations from NSW residents aged 10-24 years. ED presentation rates in regional and remote areas were more than twice (incidence rate ratio 2.23, 95% confidence interval 2.08-2.39) and four times (incidence rate ratio 4.32, 95% confidence interval 3.84-4.87) that, respectively, of major cities. Compared to major cities, youth presenting to regional and remote facilities spent 36% and 60% less time in ED, respectively, with presentations less likely to be deemed critical, occur after-hours or result in hospital admission. Variation between inland and coastal regional indicators was minimal. CONCLUSIONS Patterns of ED utilisation between major city, regional and remote youth were distinctly different, but not so between coastal and inland regional youth. Further research could better understand ED utilisation among youth and the drivers of higher presentation rates in regional and remote areas.
Collapse
Affiliation(s)
- Sally Butler
- School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia
| | - Julie Tall
- Health Intelligence Unit, Western NSW Local Health District, Orange, New South Wales, Australia
| | - Georgina M Luscombe
- School of Rural Health, The University of Sydney, Orange/Dubbo, New South Wales, Australia
| |
Collapse
|
2
|
Ellem R, Pickering R, Marks D, Todd J, Brown J, Roberts S, Michaleff ZA. Emergency presentations for older persons with low back pain: An increasing clinical and economic challenge. Australas J Ageing 2023; 42:742-750. [PMID: 37799007 DOI: 10.1111/ajag.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To determine whether differences exist for older persons presenting to Emergency Departments (EDs) with lower back pain (LBP) in terms of management, health service resource use and cost when compared to younger patients with LBP. METHODS Retrospective analysis of routinely collected electronic medical record data from January 2015 to July 2021. Data from 11,098 adults presenting with LBP to two large regional Australian EDs were analysed over a 5-year period. Rates of presentation, investigation, medication use, spinal surgery and cost were assessed for all participants with respect to age groups (over or under 65 years of age), diagnosis and time. Multivariable logistic regression analysis was employed to assess the contribution of presentation characteristics to the risk of inpatient admission and to investigate the variable effect of patient age. RESULTS Older people represented 23% (n = 2565) of all LBP presentations, with a growing proportion of presentations over time. More than 1 in 4 patients over 65 were admitted (n = 703, 27%), with CT imaging being proportionately three times more prevalent (24% vs. 6%), and average cost double (AU$3973 vs. $1671) that of the younger population. Consultation by an ED physiotherapist was associated with lower admission risk across all adult presentations (OR 0.52, 95% CI [0.40 to 0.67]). CONCLUSIONS Older persons are over-represented amongst gradually increasing rates of LBP presentations to EDs and associated with escalating cost of care and hospital resource use. Older patients present a different clinical and economic profile to younger patients, supporting the provision of individualised management recommendations.
Collapse
Affiliation(s)
- Rod Ellem
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rowan Pickering
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Darryn Marks
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - James Todd
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Jarryd Brown
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Shelley Roberts
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Zoe A Michaleff
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- New South Wales Health, St. Leonards, New South Wales, Australia
| |
Collapse
|
3
|
Stephens AS, Dinh MM, Kinsman L. Patterns of emergency department use in rural and metropolitan New South Wales by socioeconomic status: A population-based study. Emerg Med Australas 2022; 35:489-495. [PMID: 36571146 DOI: 10.1111/1742-6723.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the patterns of ED use in metropolitan and rural New South Wales (NSW) by socioeconomic status (SES). METHODS We undertook a retrospective, population-based study of de-identified data from the NSW Emergency Department Data Collection (EDDC). The study population comprised of NSW residents who presented to an NSW public hospital ED in 2013-2019 and were registered in the NSW EDDC. Total ED presentations, negative binomial regression modelled annual changes in ED presentations over 2013-2019, and age- and sex-standardised rates of ED presentations in 2019 were assessed. RESULTS Overall, between 2013 and 2019, ED presentations increased in metropolitan and rural NSW, with mean annual percentage increases of 3.1% (95% confidence interval [CI] 2.8-3.5) and 2.5% (95% CI 2.0-2.9), respectively. This growth varied by SES, with larger increases observed in higher SES groups. The bulk of presentations in rural NSW were from individuals living in disadvantaged areas. Standardised rates of ED presentations were highest in the most disadvantaged quintiles (SES 1) and progressively decreased with increasing SES in both rural and metropolitan NSW (negative gradients). Rates were higher in rural NSW compared to metropolitan NSW across all SES quintiles for total, low acuity and non-low acuity presentations. CONCLUSIONS Negative gradients in rates of ED presentations with increasing SES were observed in both metropolitan and rural NSW. At each SES quintile, rates of ED presentations were higher in rural compared to metropolitan areas. Further research exploring the underlying causal mechanisms leading to increased ED demand in rural NSW and socioeconomically disadvantaged populations is warranted.
Collapse
Affiliation(s)
- Alexandre S Stephens
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia.,School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
4
|
Gregersen R, Fox Maule C, Husum Bak-Jensen H, Linneberg A, Nielsen OW, Thomsen SF, Meyhoff CS, Dalhoff K, Krogsgaard M, Palm H, Christensen H, Porsbjerg C, Antonsen K, Rungby J, Haugaard SB, Petersen J, Nielsen FE. Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark. Clin Epidemiol 2022; 14:409-424. [PMID: 35387318 PMCID: PMC8979568 DOI: 10.2147/clep.s338149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]). Conclusion Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.
Collapse
Affiliation(s)
- Rasmus Gregersen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Correspondence: Rasmus Gregersen, Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark, Email
| | - Cathrine Fox Maule
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henriette Husum Bak-Jensen
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian S Meyhoff
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Krogsgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Antonsen
- Executive Board, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørgen Rungby
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Steen B Haugaard
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
5
|
Robson B, McAnulty G, Secombe P. Critical care resource use associated with tourism in Central Australia. Aust J Rural Health 2021; 29:408-416. [PMID: 34085730 DOI: 10.1111/ajr.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population. DESIGN Single-centre retrospective study using prospectively collected data from January 2009 to December 2018. SETTING Australian regional intensive care unit. PARTICIPANTS All critical care admissions for patients aged over 18 years for whom postcode data were available were included. OUTCOME MEASURES Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis. RESULTS Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2 years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity. CONCLUSION Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.
Collapse
Affiliation(s)
- Briony Robson
- Intensive Care Unit, St Vincent's Private Hospital Northside, Brisbane, Qld, Australia.,Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Greg McAnulty
- Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Paul Secombe
- Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Medicine, Flinders University, Bedford Park, SA, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Vic., Australia
| |
Collapse
|
6
|
Kerr L, Kealy B, Lim D, Walters L. Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries. Aust J Rural Health 2021; 29:7-20. [PMID: 33567157 DOI: 10.1111/ajr.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high-acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. DESIGN AND SETTING A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. RESULTS Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. DISCUSSION A typology was developed to account for (a) emergency department staff on-floor, (b) emergency department staff on-call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. CONCLUSION The proposed five-tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy-makers who are seeking to improve health systems and health outcomes.
Collapse
Affiliation(s)
- Lachlan Kerr
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Benjamin Kealy
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Lucie Walters
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Mount Gambier, SA, Australia
| |
Collapse
|