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New models of care and greater focus on prevention needed to take heat off hospital emergency departments

June 2016

New data showing people with three or more long-term health conditions are three times more likely to visit an Emergency Department (ED) is further evidence of the need to pursue more efficient models of care and focus greater effort on preventive health, according to St Vincent’s Health Australia.

The data, released today by National Health Performance Authority, also showed that people who did not see, or delayed seeing, a GP due to cost were 1.3 times more likely to visit an ED than those who saw a GP when needed.

St Vincent’s Health Australia – Australia’s largest non-government provider of public hospitals – said it was clear that many people presenting at EDs, the most expensive end of the healthcare system, could be treated more appropriately, and at less cost, elsewhere.

“Today’s data confirms what we already know from our EDs in Melbourne and Sydney. Among the critical injuries and illnesses, there are many people who are there because they’re unable to access a GP after-hours, or because of their concerns around the cost of primary care, including pathology and diagnostic tests,” said St Vincent’s Health Australia’s CEO, Toby Hall.

“Take a look at the data: 2.6 million Australians, aged 15 and over, visited an ED at least once in 2013-14. More than one-in-five of these, said they thought their care could have been provided by a GP.

“We need governments and health authorities to more aggressively pursue new models of care that will take the heat off EDs and both provide better and more appropriate care to people while saving considerable funds in the process.

“We need to expand trials of more assertive triage models and improve access to after-hours GP care – including co-location of GP services with hospitals – to divert non-emergency cases to more appropriate care.

“EDs see very large numbers of patients who are non-urgent or semi-urgent – 9% and 43% of all ED presentations respectively. These patients would be more appropriately treated in either primary care or through ambulatory care clinics.

“Our modelling indicates that new Rapid Diagnosis and Treatment Centres at public hospitals would reduce the cost of treating overnight and some short-stay inpatients.

“More and better use of same-day ambulatory care clinics in public hospitals have the potential to improve both efficiency and patient outcomes.

“By treating them as ambulatory inpatients it could deliver a 10% cost saving for this group and a three-fold increase in the number of newly referred patients, now seen as outpatients, at the same cost.

“The Commonwealth must also use its upcoming budget to outline a strategy for funding effective preventive health programs over the long-term.

“Nationally, around 8% of all public hospital admissions (3% of private hospitals) are considered ‘potentially preventable’ in that they could have been better managed through community and primary care.

“In NSW there is a cluster of 34,000 patients with chronic illness who, over the space of two years, presented at emergency departments an average of 7.2 times, with 6.6 hospital admissions at an average cost of $30,000 each.

“However, it’s now been two years since the government abolished the National Preventive Health Agency and the National Partnership Agreement on Preventive Health. National leadership and momentum in this area has largely been lost.

“Effective preventive health care is critical to the long-term sustainability of the health system and has significant potential to reduce downstream health costs, including demand on public hospitals. 

“The Federal Government’s announcement of the Health Care Homes trial last month – a trial of tailored healthcare packages for 65,000 chronically ill patients – was a positive sign that it’s back in the game.

“But it must only be the start. There’s so much more to be done – and as evidenced by today’s data – the need for action is urgent,” said Mr Hall.

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