Musculoskeletal conditions are a major cause of emergency department presentations. In this Opinion paper, we argue that Australian hospital reporting and coding of musculoskeletal care are both inconsistent and underestimated. This has important implications for health service planning and policy. A more inclusive and clinically informed reporting approach is essential.
The ED workforce experiences high levels of workplace violence (WPV), but data is often poorly captured. This study aimed to review WPV incidents and rates of formal reporting.
Prospective electronic QR survey of WPV incidents in ED.
Ninety respondents reported WPV incidents in ED, compared to 45 formal reports. Most WPV cases reported by nurses were from patients and were verbal in nature. Concerningly, almost 1/5 were considering leaving the ED after the WPV incident.
WPV is a significant, ongoing, underreported issue in ED that harms staff well-being and threatens the retention of the future workforce.
To describe the association between concurrent patient volume in the emergency department (ED) and adverse outcomes for admitted patients.
This was a data linkage analysis using routinely collected data from Level six EDs in New South Wales Australia. Adult patients (aged ≥ 16 years) presenting to ED between 1 April 2022 and 31 March 2023 and admitted to an inpatient unit from ED were included. The exposures of interest were ED patient (total and admitted) volume at the time of patient arrival. The primary outcome was an adverse outcome, defined as 30-day all-cause mortality or intensive care unit admission from an inpatient ward. Multivariable logistic and Cox proportional hazards models were used to adjust for covariates.
There were 142,362 cases analysed. There was a relationship between ED patient volume deciles and proportion of adverse outcomes, increasing from 5% to 7%. The adjusted odds of adverse outcomes associated with the second quintile of total patient volume was 16% higher (odds ratio, OR [95% confidence interval] 1.16 [1.07–1.25]) and 26% higher in the third quintile (1.26 [1.17–1.36]) relative to the first quintile. Based on modelling, excess mortality associated with increasing ED patient volumes was estimated to be around 1000 deaths per annum.
We found a relationship between increasing ED patient volumes at the time of arrival and adverse outcomes for admitted patients.
Assess the effects of Age, Period and Cohort (APC) in the trends in emergency department (ED) visits in 2003–2023 in Australia.
For this retrospective observational study, we obtained data on all ED visits in Australia in 2003–2023 from the Australian Institute of Health and Welfare and applied an APC model to separate Age, Period and Cohort effects.
The total number of ED visits increased from 4,306,183 in 2003 to 7,194,861 in 2013 (67% increase). A 25% increase was observed in 2013–2023 (n = 9,014,526 visits in 2023). Rates of ED visits have increased in Australia in 2003–2023 from 218 per 1000 residents to 338 per 1000. Rates of ED visits were higher in patients aged > 85 years and have increased in 2003–2023 from 525 per 1000 to 835 per 1000 (59% increase). The increase in the number of ED visits per capita was slightly lower in those aged 65–74 (from 226 per 1000 in 2003 to 338 per 1000 in 2023, 50% increase) and those aged 75–84 years (350 per 1000 to 526 per 1000, 50% increase) compared to residents aged > 85 years.
Our APC modelling shows a deceleration in the increase in the rate of ED visits in the last decade, despite at the same age younger generations having higher rates of ED visits than older generations. The consistent increase in ED visits per capita in those aged < 75 years has major implications for healthcare planning and policies needed to reduce ED demand.
Emergency care (EC) systems provide an integrated platform for addressing urgent healthcare needs. It has been estimated that time-sensitive conditions comprise approximately half of the total burden of disease in low- and middle-income countries (LMICs), but data from the Pacific region are limited. This study sought to determine the burden of ‘emergency medical diseases’ (EMDs) in the Melanesian countries of Fiji, Papua New Guinea, Solomon Islands, and Vanuatu.
Morbidity and mortality data for Fiji, Papua New Guinea, Solomon Islands, and Vanuatu were sourced from the Institute for Health Metrics and Evaluation's Global Burden of Disease Project database (2019 dataset). Diseases were categorised into EMDs and non-EMDs based on previously published definitions, namely, whether their assessment or management is time-sensitive or not. Descriptive statistics were used to summarise the burden of EMDs, with disability-adjusted life years (DALYs) used as the primary measure of morbidity.
EMDs account for 43%–60% of mortality and 37%–52% of morbidity in Fiji, Papua New Guinea, Solomon Islands, and Vanuatu. The five most prevalent EMDs in these countries (ischaemic heart disease, stroke, injuries, lower respiratory tract infections, and diarrhoeal illnesses) cause 37%–60% of all deaths.
Approximately half of all pre-pandemic mortality and morbidity in Melanesia is attributable to EMDs. This is consistent with previously reported literature for LMICs and confirms the need for resilient EC systems in the Pacific.
Peer review is a cornerstone of modern scientific publishing, yet its current form is a relatively recent development that became institutionalised in the mid-20th century. While intended to ensure rigour, credibility and quality control, the peer review system now faces mounting pressures. Rapid growth in manuscript submissions, reliance on unpaid reviewer labour, reviewer fatigue and the rise of predatory journals have strained its effectiveness. These challenges contribute to delays, inconsistent review quality and increasing retraction rates, highlighting vulnerabilities that peer review often fails to detect at scale. Evidence from randomised trials suggests that most proposed reforms offer limited benefit, although adding statistical reviewers and adopting elements of open peer review produce modest improvements. Sustainable reform will require evidence-guided changes, better recognition of reviewer contributions, and careful integration of technological tools to preserve the integrity of scientific publishing.
Increasing ED-CT Pulmonary Angiography (CTPA) use raises concerns about overuse and low yield. CTPA numbers at Sir Charles Gairdner ED were seemingly increasing. This single-site, retrospective, observational study looked for increasing usage over ten years, and whether lower yields suggested over-testing.
Two linked hypotheses: (1) CTPA rates increased over a decade and (2) if CTPA is increasing significantly, yield reduces suggesting overuse. For Hypothesis 1, ED-CTPA per 1000 attendances 2014–2023 were calculated from radiology imaging data. For Hypothesis 2, 2023/24 CTPA results were reviewed for demographics, PE diagnosis, imaging quality, and largest vessel with PE, using similar methods to previous studies. We calculated 700 cases needed reviews if CTPA increased 5%–6% annually (previous regional studies) and yield decreased inversely. Statistical analysis compared rates over time and compared 2012–2013 versus 2023–2024 for Hypothesis 1. For Hypothesis 2, analysis was for difference in proportions for yield (and largest vessel with PE) versus previous 2012–2013 data.
Rates of ED-CTPA increased 65% over 2014–2023 but yield was stable (16.3% vs. 15.7%). PE diagnoses increased by over 60% (1.3–2.1 PE/1000). Large vessel PE (≥ lobar) decreased significantly (59.9%–40.5%), intermediate-vessel PE increased (20%–35.1%), but small vessel PE was unchanged (19.2 vs. 24.3%). Women ≤ 50 years had significantly lower yield (5.4%).
CTPA use increased markedly, without expected decreased yield. Increased PE diagnosis rates suggest maintained diagnostic discrimination. Large vessel PE proportions reduced, but small PE rates didn't increase significantly. Younger women seem over-investigated with low yield (5.6%) versus all other groups.
To develop a clearer understanding of what ‘quality in emergency care’ means from the perspective of patients and families to assist with the development of consumer-informed measures of quality for emergency care in an Australian setting.
Qualitative analysis of transcripts from three semi-structured focus groups, with 24 participants recruited using purposive sampling from a pre-existing consumer expert Safer Care Victoria (SCV) panel. The focus groups were audio-recorded, transcribed and de-identified. Thematic analysis was performed using NVivo software.
Six major themes were identified: Staff-patient interactions, Provision of information, Time spent in the ED, Emotional experience, Needs of specific groups and Perception of the emergency care system. Patient and carer experiences of accessing emergency care are highly influenced by the nature of their interactions with staff and the ease and accessibility of information exchange. Prolonged ED wait times are a negative experience; however, this can be improved with attention to symptom management, comfort and privacy. The needs of priority patient groups (e.g., patients with disabilities or people of older age) may be frequently overlooked in ED settings. Participants in this study reported that many of the negative aspects of emergency care they experienced may be attributed to the system being overburdened/staff having insufficient time.
Consumer-informed measures of quality in emergency care should address staff-patient interactions, emotional experience, information provision, time spent in the ED and be sensitive to the needs of priority groups.
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