A comparison between Urgency Related Groups and the Australian Emergency Care Classification Clare Searson and Laura Harris
Introduction Emergency departments are dedicated hospital-based facilities specifically designed and staffed to provide 24-hour emergency care. The role of the emergency department is to diagnose and treat acute and urgent illnesses and injuries (Independent Hospital Pricing Authority [IHPA] 2019a). Annually, there is an increasing demand on emergency departments in Australian public hospitals. The average emergency department presentation growth from 2013-14 to 2017-18 was 2.7% per annum, which surpasses the average growth of the population over the same period. Total emergency department presentations have increased 11% over the past 5 years, and in the 2017-18 financial year presentations exceeded 8 million (Australian Institute of Health and Welfare [AIHW] 2018a, p.4). Consequently, national emergency department expenditure is increasing year on year. Due to an 8% increase from the previous year, the 2016-17 financial year expenditure exceeded $5 billion (IHPA 2019b, p13). While this increase in expenditure may be associated with improved costing processes in public hospitals, the trend correlates with the increased number of presentations and therefore resource utilisation required for service delivery. Due to an ageing population, increasing life expectancy and prevalence of chronic and complex diseases (AIHW 2018b) the number of presentations and therefore demand on Australian emergency departments will continue to rise. To ensure optimal resources are available for emergency department care delivery, the development of a new emergency care classification, which better accounts for patient complexity and cost variation, is required.
to an ageing population, increasing “lifeDue expectancy and prevalence of chronic and complex diseases the number of presentations and therefore demand on Australian emergency departments will continue to rise.
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Currently, IHPA classifies care provided by emergency departments utilising the Urgency Related Groups (URG) system. The care provided by emergency services are classified according to the Urgency Disposition Groups (UDG) system (IHPA 2019c). For example, an emergency service in a small rural hospital staffed with an on-call visiting medical officer would classify patient activity utilising the UDG system rather than the URG system, due to limitations in data collection at smaller hospitals. The URG and UDG systems were adopted as an interim measure to classify emergency care for the purpose of activity-based funding (ABF), which was nationally implemented in July 2012. In 2013 IHPA commissioned an investigative review, conducted by Health Policy Analysis, to determine whether current systems appropriately classified emergency care and whether more suitable classifications were available. The review determined that current classification systems were not appropriate for ABF on a long term basis. This was due to the reliance on triage category as a proxy measure for patient complexity, restricted capacity for classification refinements, and limited clinical meaning (Health Policy Analysis 2014). The review explored alternative national and international emergency care classifications for use
9 HIM-INTERCHANGE • Vol 10 No 1 2020 • ISSN 1838-8620 (PRINT) ISSN 1838-8639 (ONLINE)
