REDIRECT: An analysis of the nature and drivers of avoidable emergency department presentations by the elderly in metropolitan Melbourne, Australia

Talk Code: 

The problem

An increasing number of older people (those aged ? 70 years) in Australia are attending Emergency Departments (EDs) with General Practice (GP)-type conditions. This study seeks to understand the nature and drivers of avoidable ED visits by older patients, and to propose appropriate alternative models of care in primary health and community settings to reduce the number of these presentations. The approach : A mixed methods research approach was used, comprising: (i) quantitative analyses of 4 highly relevant datasets, (ii) a rapid review of the literature to identify strategies to reduce unnecessary ED presentations, and (iii) qualitative in-depth interviews and focus groups discussions with key service providers and older people to determine the feasibility of interventions aimed providing care options to reduce avoidable ED attendances. The study was based on elderly residents (n ? 70,000) of the Inner East Melbourne Medicare Local (IEMML) area. Here we present the findings of analysis of public hospital ED presentations and utilisation of an after-hours home-visiting medical deputising service for this patient group for the period 2008-2012. Findings : 15.1% of ED attendances by those over 70 years were avoidable, that is, the patient attended with a GP-type presentation. Of these, 9.3% were referred to the emergency department by a general practitioner. For 9% of the GP-type presentations, the patient departed the emergency department before receiving any clinical advice or before treatment was completed. Approximately 20% of elderly patients visited an ED as many as four times or more in a year with avoidable GP-type conditions. Disorders of the eye, a wound or fracture of the wrist or hand, and urinary tract infections were some of the most common reasons for avoidable ED attendances. 45% of GP-type presentations resulted in a referral from ED to a general practitioner for continuing care of the patient. The after-hours home-visiting medical deputising service was used predominately by Residential Aged Care Facilities, and much less frequently by community-dwelling elderly. Almost 5% of community-dwelling persons seen by the deputising service had initially phoned an ambulance. The ambulance triage process referred these patients to an after-hours general practitioner as the most appropriate treatment pathway. This suggests there is unmet potential for this type of primary health care service to reduce inappropriate hospital attendances. Consequences : In Australia, avoidable presentations continue to be a sizeable proportion of ED attendances and primary care initiatives to reduce unnecessary ED visits are on the health care reform agenda. Our study specifically addressed presentations by the elderly and the unique characteristics of this age group which influence ED use for non-emergency conditions. The findings from this study will inform the development of new primary care service options for our older citizens.


  • Danielle Mazza, Inner East Melbourne Medicare Local
  • Angela Joe, Inner East Melbourne Medicare Local
  • Judy Lowthian, Inner East Melbourne Medicare Local
  • Colette Browning, Inner East Melbourne Medicare Local
  • Bianca Brijnath, Inner East Melbourne Medicare Local
  • Lyle Turner, Inner East Melbourne Medicare Local
  • Marianne Shearer
  • Christopher Pearce