Innovation in after-hours care lowers ED visits for non-urgent cases

Innovation in after-hours care lowers ED visits for non-urgent cases

14 September, 2020

According to a new report by the Australian Institute of Health and Welfare (AIHW), over a third (2.9 million) of Emergency Department (ED) presentations were classified as requiring lower urgency care in 2018-2019 nationally. Of these lower urgency care ED presentations, just under half (47%) were in the after-hours. 1

The new findings suggest many of these lower urgency presentations could have been appropriately managed by general practices (GPs).

Eastern Melbourne PHN (EMPHN) developed its After-Hours Strategy in a bid to reduce lower urgency care presentations to EDs as well as increase the efficiency and effectiveness of after-hours primary health care for patients, particularly those with limited access to health services, in eastern and north-eastern Melbourne.

EMPHN CEO Janine Wilson said EMPHN has implemented innovative solutions to address service gaps to improve access to after-hours primary health care.

“In the EMPHN region, lower urgency ED numbers have seen a sharper decline compared to the national average,” she said.

Lower urgency ED numbers in EMPHNs community have dropped 7.1% between 2015 and 2019, compared to a drop of only 0.9% nationally on average.

In addition, EMPHNs after-hours lower urgency ED presentations have continued to decline year on year, dropping 7.9% in 2019 from 2015. 2

EMPHN funded after hours programs such as the After-Hours Medical Neighbourhood by Nexus Primary Health, ED Diversion Project and the My Emergency Doctor service have assisted the decline in lower urgency ED numbers in the community.

After-Hours Medical Neighbourhood is an expanded patient centric care model where primary care and specialty providers, hospitals and other clinicians work together in partnership to provide complete and coordinated care. As part of this project, Nexus enhances the after-hours availability of services by opening extended hours and establishing an engagement approach, targeting vulnerable populations. Part of the program incorporates enhancement of care during the day to reduce the need for after-hours care.

Nexus CEO, Amanda Mullins, said Nexus employs Health Systems Navigators as part of the program to provide a welcoming point of connection for vulnerable populations with a focus on engagement and support, to identify and address health care needs, particularly in the after-hours.

The After-Hours ED Diversion Project is a collaboration between local GPs and hospital networks. Formalised protocols and procedures are established to redirect patients attending ED to local GPs who are open with extended hours and have the capacity and capability to treat appropriate patients.

EMPHN commissioned My Emergency Doctor to provide semi–urgent to urgent after-hours telehealth consultations to patients living within the EMPHN catchment, including residents in residential aged care facilities. Doctors provide online emergency consultations, including prescription, x-ray and pathology referrals with post-consultation summaries available to be sent to the patient’s regular GP with the patient’s permission to complement the primary care pathway. Almost 50% of callers to My Emergency Doctor would have otherwise attended the emergency department and the service has reduced ED attendance by 36.7%.

EMPHN has also commissioned Eastern Health to provide an after-hours clinic in Healesville. The clinic provides after-hours GP Services for residents of the Healesville and surrounding community who have no access to home visits from a locum service and limited access to GPs after- hours.

For more information, visit the EMPHN after hours page.