by Jonathan Karnon, Charmaine Gray,The Conversation

Credit: Country to Coast QLD/facebook.com, Wikimedia, Canva, The Conversation

When we're acutely ill or injured, we want to be able to quickly access care in Australia's hospital emergency departments (EDs). But more of us are seeking care in EDs. This went from7.4 millionin 2014–15 to9.1 millionin 2024–25. And the system is struggling to cope.

EDs are becoming more crowded and patients are staying in EDs for a lot longer. Around 10% of patients waiting for an inpatient bedspent 19 or more hours in an ED—six hours longer than they would've waited four years ago.

Around 10% of patients who were discharged home spent eight or more hours in an ED—almost two hours longer than four years ago.

Improving access to inpatient bedsfrom the ED is an important part of reducing ED overcrowding. But so too are strategies to reduce the number of patients presenting at EDs.

Since the May election, the federal government has beenspruiking its expanded networkof Urgent Care Clinics to reduce ED presentations for patients with urgent but non-life-threatening conditions.

But how are they working? And how do they fit with other services that have a similar aim of keeping Australians out of hospital?

Three free services are in place to divert patients who don't need to go to hospital to more appropriate settings—or to direct them to an ED if they are critically ill:

Healthdirect(called Nurse-on-call in Victoria) is a24/7 phone advice service operated by nursesand has been in operation since 2006. It gives callers health advice, including whether they should see a GP or go to an ED.

Urgent Care Clinicsare anetwork of around 90 health services, mainly staffed by GPs, where patients can walk in without an appointment and receive treatment for urgent but non-life-threatening conditions. They're open every day, from early in the morning until late at night and can provide diagnostic services such as blood tests and X-rays.

Virtual ED servicesprovideconsults via a video link with specialist ED physicians and other clinicians. Over the past five years, virtual EDs have been established in Victoria, South Australia, Queensland, Western Australia and New South Wales. Health providers can call virtual ED services for advice about where to send a patient.

There is little published evidence evaluating the three services, though significant evaluations ofUrgent Care Clinicsandvirtual EDsare underway.

Theinterim evaluation of Urgent Care Clinicsreported no data on the safety and quality, but noted that before opening, clinical assessments were conducted to confirm their safety and readiness to operate.

Anevaluation of a virtual ED service in New Zealandreported similar seven-day re-presentation rates for virtual and traditional EDs. This means a similar proportion of patients need to go back for further care, suggesting patients receive a similar level of care in both types of EDs.

We want to be confident patients who would otherwise have presented at an ED are using these services and that they're an efficient use of health budgets.

Theearly evaluation of Urgent Care Clinicsfound 46% of Urgent Care Clinic patients would have otherwise presented at an ED. Some 5% of patients using an Urgent Care Center were referred to an ED.

So Urgent Care Centers avoided four in ten ED presentations and resulted in a small reduction in health service costs.

Data from virtual EDsin Queensland and Victoria show 30% of patients are then referred to a physical ED. This suggests virtual EDs manage patients with more serious conditions than Urgent Care Clinics.

Aneconomic evaluation of an early virtual ED servicein Victoria also estimated a small reduction in health service costs, assuming all patients would otherwise have presented at an ED, but none would have been admitted. Other scenarios generated larger estimated cost reductions.

Published data on Healthdirectshows 69% of patients attended an ED and 65% consulted a doctor when advised. One review reported Healthdirect generated "modest but significant" reductions in ED usage and after-hours GP visits.

We can improve these services, in particular, how the services integrate with each other.

Half of patients using an Urgent Care Clinic said they would haveseen a GP if they hadn't used the clinic. If patients had better access to GPs, it would free capacity for more patients who would have presented at an ED to get treated in Urgent Care Clinics.

Most virtual EDs are relatively small scale, other than in Victoria, where the virtual ED takesmore than 700 calls per day. This suggests there is capacity to increase the scale of virtual EDs, which should reduce average costs.

Virtual EDscan refer patients to Urgent Care Centers to access diagnostic services, and Urgent Care Centers can call virtual EDs for specialist advice. Research is needed to evaluate the effectiveness of the linkages between Urgent Care Centers and virtual EDs.

Healthdirect refers patients to GPs, Urgent Care Clinics, EDs and virtual EDs. We need more research to assess the appropriateness of these referrals to identify opportunities to improve the use of these different health services.

While the three services target overlapping groups of patients, they're currently evolving independently. Instead, we need to develop, implement and evaluate a plan for the integrated delivery of these services.

Each service can help keep Australians out of hospital, but the value of an integrated approach will be greater than the sum of the individual services.

This article is republished fromThe Conversationunder a Creative Commons license. Read theoriginal article.

Key medical concepts Care Center, Urgent Emergency Service, Hospital General Practitioners

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