title: Low-acuity presentations to regional emergency departments: What is the issue?
abstract: OBJECTIVE
  To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED.
  
  
  METHODS
  Retrospective analysis of all ED presentations to Mersey Community Hospital and North West Regional Hospital (Tasmania) between 1 January 2009 and 31 December 2013. Cross-sectional survey of patients presenting to the EDs for care triaged as low-acuity.
  
  
  RESULTS
  There were 255,365 ED presentations in the retrospective data: 11,252 (4.4%) GP-referrals and 218,205 (85.4%) self-referrals. At ED 49% of GP-referrals were triaged ATS 4 or 5 and 35% of self-referrals were triaged ATS 1-3. There were 138 (84.2%) low-acuity patients who completed the survey; predominantly, all attended for acute injury or illness. Single point-of-care convenience was most commonly selected (71%) as a reason for attending ED.
  
  
  CONCLUSIONS
  Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types.
authors.affiliation: Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.
authors.forename: Colleen
authors.initials: C
authors.lastname: Cheek
authors.affiliation: Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Allen
authors.affiliation: Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.
authors.forename: Lizzi
authors.initials: L
authors.lastname: Shires
authors.affiliation: Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia.
authors.forename: Denise
authors.initials: D
authors.lastname: Parry
authors.affiliation: Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia.
authors.forename: Marielle
authors.initials: M
authors.lastname: Ruigrok
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data; D013648:Tasmania; D055815:Young Adult
keywords: cost; demand; funding; general practice; health-seeking behaviour; low-acuity presentations; regional hospital