Emergency Health Services (EHS): Demand and service delivery models - Monograph 4: Demand management and policy options

The emergency healthcare system (EHS) is a critical component of Australia’s healthcare system. The EHS has been fundamentally reformed over the last four decades with the development, upgrading and modernisation of both ambulance services and Emergency Departments (EDs) and the emergence of new professions of Paramedic, Emergency Physician and Emergency Nurse. These changes have unquestioned impact on improving the standards and quality of care and therefore on the outcomes for patients suffering acute illness and injury. However, emergency health services are increasingly congested from the combined impact of growing demand for care and blocked access to inpatient beds and this congestion has proven adverse clinical, organisational and staff impacts. However, often the public, bureaucratic and political perspective is that this problem somehow reflects at worst gaming of the system and at best inefficiency and so public policy solutions have been underpinned by blaming someone for the problem; either the patient, the Commonwealth/States or the providers. Phrases such as “inappropriate attendance”, GP patients, frequent flyers, unrealistic expectations and provider induced demand have characterised much of the public discourse. The feasible alternative proposition is that there are more sick people seeking care and exercising largely thoughtful and wise choice of the most appropriate source of that care. The Emergency Health Services Queensland (EHSQ) study was a program of research funded by an ARC Linkage grant which sought to describe the trends in EHS demand, to identify the factors driving increased demand and to evaluate strategies which may safely reduce the future demand growth. Our research findings, which largely align with similar studies across Australia and in similar jurisdictions, has demonstrated the demand is growing across all developed nations; it is growing amongst the more urgent categories of patients, across all age groups and a broad range of clinical conditions. There is no evidence of widespread misuse (however so defined) nor is there any evidence that the growth in demand will not continue at the current rate. On all the evidence we have identified the growing demand represents: The legitimate and reasonable choice of patients suffering acute illness and injury to seek care at a location they perceive to offer the most appropriate and safest assessment and intervention. The question underpinning this aspect of the research is ‘can anything be done to moderate the growing demand while still offering safe, appropriate and efficient care?’ The aim of this the final report of this research is to summarise the findings and to place those findings within the context of the public literature, to identify what is known about the application of these findings into public policy and to make recommendations for future research and the future direction of acute health services. This study involved a detailed review of the literature to identify intervention strategies and a policy evaluation undertaken with the support of stakeholder interviews. The strategies that may moderate the growth in demand may be broadly categorised into three categories: 1. Enhanced prevention 2. Management in situ 3. Diversion to alternative services. The analysis of policy options has confirmed there is no single or even small group of interventions likely to make a difference. One distinct possible policy alternative is that the current arrangements offer the most efficient and effective means of providing the required care and so ongoing expansion of those services may be most appropriate. However, the alternative is a comprehensive suite of strategies properly coordinated at both policy and operational levels to ensure patients have access to a range of services from which they may choose the most appropriate to their needs after weighing up the social, clinical and financial implications. Additional research is required to develop and evaluate these strategies including the economic, clinical, professional and social costs and benefits