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Systematic review of trends in emergency department attendances: an Australian perspective
  1. Judy A Lowthian1,
  2. Andrea J Curtis1,
  3. Peter A Cameron1,
  4. Johannes U Stoelwinder1,
  5. Matthew W Cooke2,
  6. John J McNeil3
  1. 1Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
  2. 2Emergency Care and Systems Improvement Group, Warwick Medical School & Emergency Medicine Consultant, Heart of England NHS Foundation Trust, United Kingdom
  3. 3School of Public Health and Preventive Medicine, Monash University, Australia
  1. Correspondence to Judy Lowthian, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6 Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia; Judy.Lowthian{at}


Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion campaigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand.

  • Emergency care systems
  • emergency departments
  • research
  • epidemiology

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  • Funding JL is the recipient of a NHMRC postgraduate research scholarship.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Monash University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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