Emergency care definition consensus the first step to better care

Sunday, May 6, 2012


Agreeing on the definition of a 'health emergency' may be the first step to reducing inappropriate use of hospital emergency departments and ambulance services, according to a new study in the Australian Health Review.

This study is reported in the most recent edition of the Australian Health Review, the peer reviewed journal of the Australian Healthcare and Hospitals Association.

"In the current climate of increased demand for healthcare, and increasing patient expectations, there are growing concerns about the ‘inappropriate’ utilisers of emergency health services", said study leader Dr Amee Morgans from Ambulance Victoria.

"This includes patients who seek emergency healthcare when they are not acutely unwell (inappropriate health service users) and some patients who fail to seek emergency healthcare when they are acutely unwell (patients who ‘delay’ or avoid using emergency health services).

"This study aimed to explore the definition of a health emergency to further the debate about appropriate and inappropriate use of emergency health services in Australia. It included a review of Australian and international rates of ‘inappropriate’ healthcare utilization and identifies the limitations on the ability to determine whether patients were appropriate or inappropriate, and instead identifies what motivates patients to seek emergency healthcare for non-acute events and fail to seek healthcare for acute events.

"The review found that there is a wide variety of definitions of inappropriate use, including lists of symptoms or conditions, legal definitions, but the interpretation of these was largely subjective and usually retrospective. Also, the issue of whose responsibility it is to determine inappropriateness, and for what purposes (such as resource allocation purposes compared with patient education purposes) was rarely considered when deciding on a system of classification, and these different systems identified different patient cohorts.

"We also found that there is a difference in understanding between health professionals and patients about what a health emergency is and when it is appropriate to seek emergency healthcare. Because there is no universally accepted definition of what constitutes a health emergency, it is often difficult to compare the findings of investigations into inappropriate utilization of emergency health services.

"While the word 'inappropriate' implies that there is an intention to deliberately misuse the emergency health services, the evidence suggests that many patients are actually reluctant to use emergency health services, even when use is appropriate.

"This highlights the need for better education of both laypeople and health professionals. Education strategies would need to focus on reducing delay seeking help when needed, what services are provided by GPs, ambulance services and EDs, and guidance about the clinical urgency of symptoms and the most appropriate source of care for managing these.

"Education strategies such as these, based on an agreed definition of a 'health emergency', are essential to manage the growing demand for emergency services, Dr Morgans said.

For further information/comment:  Dr Amee Morgans 03 9840 3746 |