When we become seriously ill or injured, we want to be able to receive care quickly in an Australian hospital emergency department (ED). But more of us are receiving treatment in emergency rooms. This went from 7.4 million In 2014-15 9.1 million In 2024-25. And the system is struggling to cope.
Emergency rooms are becoming increasingly crowded, and patients are staying there much longer. Approximately 10% of patents awaiting inpatient beds I spent over 19 hours in the emergency room. – 6 hours longer than the wait 4 years ago.
About 10% of patients discharged home spent more than eight hours in the emergency room, nearly two hours more than four years ago.
Improving access to inpatient beds in emergency departments is an important part of reducing emergency room overcrowding. But so too are strategies to reduce the number of patients presenting to emergency rooms.
After the May election, the federal government Strengthen your extended network Introduction of urgent care clinics to reduce emergency room presentations for patients with urgent but non-life-threatening conditions.
But how do they work? And how does it fit in with other services with similar aims to keep Australians out of hospital?
In public hospitals, it seems like everyone is waiting – emergency treatment, elective surgery, ward admission. Private hospitals are also experiencing difficulties. In this five-part series, experts explain what goes wrong, how patients are affected, and potential solutions.
What’s going on now?
Three free services are available to help transition patients who do not need to go to hospital to a more appropriate setting or, if critically ill, to the Emergency Department.
Health Direct (called nurse-on-call in Victoria) 24-hour telephone counseling service operated by nurses It has been in operation since 2006. Provide health advice to callers, including whether they should see their GP or go to the emergency room.
urgent care clinic area Approximately 90 health service networksOften staffed by GPs, patients can walk in without an appointment and receive treatment for urgent but non-life-threatening conditions. We are open daily from early morning until late at night and can provide diagnostic services such as blood tests and X-rays.
Virtual ED Services We provide consultations via video link with specialist emergency room doctors and other clinicians. Over the past five years, virtual EDs have been established in Victoria, South Australia, Queensland, Western Australia and New South Wales. Healthcare providers can call the virtual emergency room service for advice on where to send the patient.
Read more: What is a virtual emergency room? And when should you ‘visit’?
We know very little about quality and safety.
Although there is little published evidence evaluating the three services; urgent care clinic and virtual ED It’s in progress.
that Interim Evaluation of Urgent Care Clinic It did not report safety and quality data, but noted that clinical evaluations were conducted to ensure safety and operational readiness prior to opening.
not Evaluating New Zealand’s virtual emergency room service Similar 7-day reproducibility rates have been reported for virtual and traditional EDs. This means that a similar percentage of patients must return for additional treatment, which means that patients receive similar levels of care in both types of emergency rooms.
Will the burden on hospitals be reduced?
We want to be confident that patients who would otherwise visit the emergency room are using these services and that their health care budgets are being spent efficiently.
that Early Evaluation at Urgent Care Clinic We found that 46% of urgent care clinic patients would otherwise have gone to the emergency room. Approximately 5% of patients attending urgent care centers are referred to the emergency room.
As a result, urgent care centers prevent 4 out of 10 emergency room visits and achieve small savings in health care costs.
Data from the virtual ED In Queensland and Victoria, 30% of patients are actually referred to emergency departments. This means that virtual emergency rooms manage patients with more serious conditions than urgent care clinics.
not Economic evaluation of initial virtual ED service In Victoria, we estimated that there would be a small reduction in health care costs assuming that all patients were admitted to the emergency department but none were hospitalized. Other scenarios resulted in larger expected cost savings.
Data published on Healthdirect 69% of patients attended the emergency department and 65% consulted a physician when advised. One review found that Healthdirect reported “moderate but significant” reductions in emergency department usage and out-of-hours GP visits.
How can we improve these services?
We can improve these services, especially how they integrate with each other.
Half of patients who use urgent care clinics say they will experience: If you don’t go to a clinic, visit your GP. If patients had better access to their GP, more patients presenting to emergency departments could afford to be treated at urgent care clinics.
Most virtual EDs are relatively small, except in Victoria, where virtual EDs dominate. Over 700 calls per day. This means you have the ability to increase the size of your virtual ED, which will reduce your average cost.
The virtual emergency room can refer patients to an urgent care center for diagnostic services, and the urgent care center can call the virtual emergency room for expert advice. Research is needed to evaluate the effectiveness of linkages between urgent care centers and virtual emergency departments.
Healthdirect directs patients to GPs, urgent care clinics, emergency departments and virtual emergency rooms. More research is needed to evaluate the appropriateness of these referrals to identify opportunities to improve the use of these different health services.
The three services target overlapping patient groups but are currently developing independently. Instead, we must develop, implement, and evaluate plans for the integrated provision of these services.
Each service can help Australians stay out of hospital, but the value of an integrated approach will be greater than the sum of the individual services.
Learn more about our Hospitals in Crisis series here.
