Overview
Each year, ACEM distributes the Annual Site Census to Directors of Emergency Medicine and Directors of Emergency Medicine Training at all ACEM-accredited emergency departments (ED) across Australia and Aotearoa New Zealand. Findings from the census are used to monitor activity, staffing and resources of accredited sites and provide an evidence base for ACEM policy and advocacy initiatives relating to ED workforce and functioning.
The 2023 site census was distributed to 148 ACEM-accredited sites. ED activity and case mix data were sought from 1 July 2022 to 30 June 2023, with all other data being current at the time of completing the survey.
All 148 ACEM-accredited sites (129 in Australia and 19 in Aotearoa) submitted the 2023 census. Data is reported by region (country/state or territory) and hospital peer group. For Australian EDs, the peer group description from the Australian Institute of Health and Welfare (AIHW) MyHospitals multilevel ED data was used for the peer group classification (AIHW – Emergency department care). Due to a lower number of reporting EDs small and medium regional EDs were combined. For Aotearoa, EDs were classified using the Stats NZ Functional urban areas (FUA) which comprises four peer groups: Metropolitan, Large regional, Medium regional and Specialist (Stats NZ, 2021). Only one Specialist Children’s Hospital in Aotearoa is an ACEM-accredited ED, so their data has been incorporated into the Metropolitan classification to maintain the hospital's anonymity. Additionally, large and medium regional EDs have been combined.
Key data is shown in the visuals on this page with more comprehensive data available in the supplementary file that can be downloaded at the bottom of the page.
ED activity and case mix
From 1 July 2022 to 30 June 2023, a total of 8,415,245 attendances were reported at ACEM-accredited EDs. The average number of annual ED attendances was 57,031 at Australian EDs (1.7% increase vs. 2022 census) and 55,700 at Aotearoa New Zealand EDs (6.3% increase vs. 2022 census) (Figure 1).
Figure 1 also shows the proportion of attendances that were aged 0 – 14 years and 65+ years, the proportion admitted to the hospital as inpatients and to an ED short stay unit, and the proportion of patients that arrived by ambulance.
Figure 1. ED activity and case mix by region and hospital peer group
24-hour length of stay
Between 1 July 2022 and 30 June 2023, 172,975 attendances to ACEM-accredited EDs were reported to have a length of stay over 24 hours. Tasmanian EDs had the highest proportion of total ED attendances with a length of stay greater than 24 hours (5.1%). Large regional EDs in Australia and large/medium regional EDs in Aotearoa New Zealand had the highest proportion of total attendances with a length of stay greater than 24 hours, at 2.7% and 1.9% respectively (Figure 2).
Across ACEM-accredited EDs, the proportion of discharged patients who had a length of stay greater than 24 hours (0.3%) was significantly lower than the proportion of inpatient admissions (3.9%), inter-hospital transfers (6.4%) and ED SSU admissions (5.3%).
Figure 2. ED length of stays greater than 24 hours by region and hospital peer group
EM specialist and FACEM trainee staffing profiles
The average full-time equivalent (FTE) of EM specialists across ACEM-accredited EDs was 15.9. The average FTE of FACEM trainees in training stage 1 was 4.2, compared with 8.4 FTE for those in training stages 2 – 4 (Figure 3).
The EM specialist FTE to headcount ratio was 1 : 1.6, meaning an average of 1.6 emergency medicine specialists were required to fill every 1 FTE position. On average, accredited EDs had 0.7 FTE of FACEM trainees for every 1 FTE of EM specialists. Figure 3 also shows the ratio of emergency medicine specialists, FACEM trainees, all ED medical staff and nursing staff to ED attendances.
Figure 3. EM specialist and FACEM trainee staffing profiles by region and hospital peer group
EM specialist and FACEM trainee vacancies
The proportion of accredited EDs with funded but unfilled FTE (i.e. vacancies) for EM specialists was comparable between 2022 (53.1%) and 2023 (54.1%) site census. Positively, the proportion of accredited EDs reporting FACEM trainee vacancies reduced from 76.2% in the 2022 census to 65.5% in the 2023 census.
The hospital peer groups with the highest percentage of EDs reporting EM specialist vacancies were large regional (78.3%) and small/medium regional (77.8%) EDs in Australia. The hospital peer groups with the highest percentage of EDs reporting FACEM trainee vacancies were large regional (78.3%) and large metropolitan (77.4%) EDs in Australia (Figure 4).
Figure 4. The proportion of EDs with EM specialist and FACEM trainee vacancies by region and hospital peer group
ED treatment spaces and resources
The average number of treatment spaces (beds and chairs) across ACEM-accredited EDs was 49.4, with one treatment space per 1,151 ED attendances. Around half of these spaces were designated as acute beds (average of 23.2 per ED), whilst the smallest number of spaces were designated as mental health assessment spaces (average of 2.3 per ED) (Figure 5).
Figure 5. ED treatment spaces and resources by region and hospital peer group
Additional data is available in the supplementary data tables below. For further enquiries about ACEMs Annual Site Census please contact [email protected].