Many Emergency Department visits could be avoided with trip to the GP

More than 70 per cent of all lower-urgency visits to Emergency Departments at Victorian hospitals between 2002 and 2013 could have been appropriately treated at GP clinics, new research has found – with the number increasing to 90 per cent among children aged 0-4 years.


And in findings which fundamentally challenge widespread community assumptions, work by the same researchers has found that same-day GP appointments for mildly ill children were available in 78 per cent of test cases; half of them within four hours of calling for an appointment, and most of them bulk billed.

The findings of the research, by University of Melbourne in partnership with The Royal Children's Hospital, were published in the Australian Family Physician and the Medical Journal of Australia respectively.

Lead researcher Professor Gary Freed, paediatrician and Director of the Health Systems and Workforce Unit at the University's Centre for Health Policy, said the findings tested the assumption that the single biggest challenge to emergency department sustainability came from adults and the ageing population.>

"Growth in ED presentations is one of the big issues facing the public health system in Victoria, and our research clearly shows that the age group with the greatest number of ED visits where care by a GP likely would have been appropriate was not adults or the elderly, but small children," Professor Freed said.

"This research also contradicts the widely-held assumption that parents take their lower-urgency ill children to hospital EDs because they cannot get, or afford to pay for, GP visits," he said.

"Small children are being taken to ED with lower-urgency conditions in increasing numbers, and yet we now know that GP appointments for those children are readily available, often within four hours and usually bulk-billed.

"We can now see that if we want to reduce the burden on hospital EDs, and reduce wait times within EDs, we need to understand the motivation behind the behaviour of Victorian families. Healthcare is profoundly important, but it's expensive to provide, and we need to find evidence-based solutions to systemic challenges.

"The first step is conducting research to better understand these problems as opposed to letting anecdotes guide policy decisions".

Professor Freed's research, using an ethics-approved 'secret shopper' methodology, found that across 225 randomly selected practices in metropolitan Melbourne plus suburban and urban areas, same-day paediatric appointments for new patients were available in 78 per cent of GP clinics. Those appointments were available within one hour in 15 per cent of clinics, and 49 per cent were able to offer an appointment within four hours. 

"But what is perhaps most significant, given the amount of public discussion this topic has attracted in recent times, was that 75% of those clinics offered bulk-billing for children," Professor Freed said.

The research was published in the Medical Journal of Australia.

The Victorian Emergency Minimum Dataset (VEMD) between 2002 and 2013 was assessed to determine the percentage of low urgency (triage category 4 or 5) presentations which complied with specified exclusion criteria, and were therefore appropriate to have been treated within primary, rather than hospital ED care. VEMD captures data of all patients presenting to 24-hour Victorian EDs, a group which includes 38 Victorian hospitals.