title: Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?
abstract: The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables.
  
  
  
  This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes.
  
  
  
  Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED.
  
  
  
  There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84).
  
  
  
  Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
authors.affiliation: Royal Prince Alfred Hospital, New South Wales, Australia The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.affiliation: Royal Prince Alfred Hospital, New South Wales, Australia The University of Sydney, School of Nursing, New South Wales, Australia.
authors.forename: Saartje
authors.initials: S
authors.lastname: Berendsen Russell
authors.affiliation: Royal Prince Alfred Hospital, New South Wales, Australia.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.affiliation: Royal Prince Alfred Hospital, New South Wales, Australia.
authors.forename: Dane R
authors.initials: DR
authors.lastname: Chalkley
authors.affiliation: University of New South Wales, School of Public Health and Community Medicine, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Muscatello
authors.affiliation: The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.affiliation: Injury Division, The George Institute for Global Health, The University of Sydney, New South Wales, Australia Flinders University, School of Nursing and Midwifery, South Australia, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D062072:Patient Acuity; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; low acuity