Avoidable emergency department visits costing SA taxpayers $22m each year

Unnecessary and repeat emergency department visits by SA’s most vulnerable residents is costing taxpayers a fortune — but there may be a simple solution.

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Avoidable and repeat emergency department visits by South Australia’s most vulnerable residents are costing taxpayers $22 million a year, new research shows.

The study by Adelaide researchers found 20 per cent of all ED presentations across five public hospitals from 2005 to 2011 were made by asylum-seekers and refugees, indigenous people, and those aged 75 and over.

One in five of the ED visits by this vulnerable group could have been treated by a GP.

The findings come after urgent calls from frontline staff last week for an extra 14 ED doctors to cope with demand and understaffing that is placing patient health at risk.

Study co-author and epidemiologist researcher David Banham, from the South Australian Health and Medical Research Institute, said that while data used in the study was historic, ED presentations continued to rise.

Mr Banham said the study’s findings starkly highlighted the unnecessary cost of avoidable ED visits and the need for SA Health to improve data collection on specific population groups — a recommendation echoed in the Health Performance Council’s 2015-18report tabled in parliament on April 4.

“Much more work needs to be invested in analysing patient flow and finding solutions to channel non-urgent health care to more culturally suitable, primary or community care settings outside EDs,” Mr Banham said.

“By understanding who is using the ED, how and why, bureaucrats and politicians will be able to invest in what people really need and where to achieve better and faster health outcomes.”

The Royal Adelaide Hospital emergency department. Picture: Calum Robertson

The study found people aged 75 and over were three times more likely to have multiple ED visits compared to all other ED users and over five times more likely to present with chronic Ambulatory Care Sensitive Conditions (ACSC).

ACSCs include ambulance presentations for asthma, urinary tract infections, dental problems, cellulitis (bacterial skin infection), congestive cardiac failure, angina or vaccine preventable disease like influenza.

Indigenous South Australians were more than two times more likely to present at EDs with acute ACSCs, while asylum seekers and refugees were almost twice more likely to visit the ED with GP-type presentations, including ear and throat infections, high blood pressure, cuts, and abdominal pain.

The study — “How much emergency department use by vulnerable people is potentially preventable” — is the first of its kind in SA and was published in February in online medical journal BMJ Open.

Adelaide University, Flinders University and UniSA researchers used data from SA Health ED information systems at the Royal Adelaide Hospital, Queen Elizabeth Hospital, Flinders Medical Centre, Noarlunga Hospital and the Lyell McEwin Hospital.

The state’s health system has been plagued by ED overloading, ambulance ramping and long wait times — a growing concern within ageing population.

The recent Health Performance Council’s 2015-18 report says current use of statistical averages by SA Health hides disparities of healthcare performance and experiences for specific population groups, including people from culturally and linguistically diverse backgrounds.

“In some postcode areas the rates of preventable hospitalisation are at least 50 per cent above the statewide averages for conditions such as asthma, diabetes and high blood pressure, and have been for a decade or more. This signals that the existing health policies are insufficient.”

An SA Health spokeswoman said improving community supports and preventive health measures was a key priority to easing pressure on emergency departments and delivering care closer to home.

“We are working with our partners in the community, particularly those supporting vulnerable populations, to provide the best care for patients that may not require treatment in a hospital,” she said.

In recent months SA Health has introduced a range of initiatives including piloting a Hospital in the Home service in the south, a hospital avoidance program in the north, and allocating specialist geriatricians, allied health and nursing staff in the RAH ED.