Access block in Australian emergency departments 2017–2020

Objective: To describe Australian ED workload over the period 2017–2020 using data from twice annual Access Block Point Prevalence Studies, and to identify any impact of the COVID-19 pandemic. Methods: Retrospective analysis of demand and occupancy data provided by the Australasian College for Emergency Medicine accredited EDs in voluntary surveys at the start of June and September 2017–2020. Hospitals answering all surveys were grouped and compared by jurisdiction and role delineation. Results: A total of 121 EDs were eligible, 63% supplied complete occupancy data and 53% complete demand data. Between the June 2017 and 2019 surveys, mean daily ED presentations increased by 11.4% (P = 0.0003). The number being treated at 10.00 hours rose by 27.7% (P < 0.0001) and those experiencing access block (waiting for an inpatient bed, been in ED more than 8 h) rose by 46.1% (P = 0.001). Between the June 2019 and 2020 surveys, ED presentations fell by an average of 12.6% (P < 0.0001), ward admissions were almost unchanged (−6.0%, P = NS), and patients who did not wait to be seen fell by 57.8% (P < 0.0001). Major Paediatric Referral hospitals reported a 28% decrease in presentations. By September 2020, only the state of Victoria (ongoing state of emergency) and Major Paediatric Referral hospitals reported demand lower than 2019 or occupancy lower than 2018. Conclusions: Occupancy increased by more than demand 2017–2019, with some decrease in 2020: in June presentations were 12.7% lower than 2019, in September back to the normal range outside Victorian and Major Paediatric Referral hospitals. Future research needs to consider locality, role delineation and work practice change in comparing ED pandemic responses.