Emergency department utilisation by older people in metropolitan Melbourne, 2008-12: Findings from the Reducing Older Patient's Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Objective. Older patients are over-represented in emergency departments (ED), with many presenting for conditionsthat could potentially be managed in general practice. The aims of the present study were to examine the characteristics ofED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations.
Methods. A retrospective analysis was performed of routinely collected data comprising ED presentations by patientsaged 70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentationswere classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non PAGP-type groups.
Results. There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified asPAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion. Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12.A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care.