ORIGINAL RESEARCH Low acuity and general practice-type presentations to emergency departments: A rural perspective Penny ALLEN, 1 Colleen CHEEK, 1 Simon FOSTER, 2 Marielle RUIGROK, 3,4 Deborah WILSON 1 and Lizzi SHIRES 1 1 Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia, 2 School of Medicine, University of Tasmania, Hobart, Tasmania, Australia, 3 Department of Emergency Medicine, North West Regional Hospital, Burnie, Tasmania, Australia, and 4 Department of Emergency Medicine, Mersey Community Hospital, Latrobe, Tasmania, Australia Abstract Objective: To estimate the number of general practice (GP)-type patients attending a rural ED and provide a comparative rural estimate to a met- ropolitan study. Methods: Analysis of presentations to the two EDs in Northwest Tasmania from 1 January 2009 to 31 Decem- ber 2013 using the Diagnosis, Sprivulis, Australian College of Emergency Medi- cine (ACEM) and the Australian In- stitute of Health and Welfare (AIHW) methods to estimate the number of GP- type presentations. Results: There were 255 365 ED pres- entations in Northwest Tasmania during the study period. There were 86 973 GP-type presentations using the ACEM method, 142 006 using the AIHW method, 174 748 using the Di- agnosis method and 28 922 low acuity patients identified using the Sprivulis method. Conclusions: The proportion of GP- type presentations identified using the four methods ranged from 15% to 69%. The results suggest that triage status and self-referral are not reli- able indicators of low acuity in this rural area. In rural areas with a short- age of GPs, it is likely that many people appropriately self-refer to ED because they cannot access a GP. The results indicate that the ACEM method might be most useful for identifying GP-type patients in rural ED. However, this requires validation in other regions of Australia. Key words: emergency department, general practice-type presentations, low acuity patients. Introduction Worldwide, health systems are grap- pling with increasing attendances to EDs. 1 In Australia, attendances at EDs have increased 17%, in the past 5 years, to over 6.7 million per year. 2,3 In- creased attendances at EDs can com- promise care by increasing wait times and length of stay; overcrowding has been shown to contribute to poorer patient outcomes and, at times, in- creased patient mortality. 4,5 Emergen- cy care is also expensive to deliver compared with other models of care. 6,7 The rate of ED presentations Australia-wide equates to approxi- mately 288 per 1000 people. North- west Tasmania has approximately 51 000 ED presentations per year, 8 a rate of approximately 451 per 1000 people, which is 1.6 times greater than the national rate. Northwest Tasmania has a popula- tion of 113 000, a fifth of the total population of Tasmania. 9 The popu- lation is socioeconomically disadvan- taged (Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage Deciles 1–5) 10 and has a high prevalence of chronic disease and lifestyle risk factors. 8 The popu- lation is geographically dispersed, with localities classified as Australian Stand- ard Geographic Classification (ASGC) Remoteness Area (RA) RA3-outer re- gional (e.g. Burnie) to RA5-very remote (e.g. King Island) (RA 3–5). 11 However, 75% of the population live in the coastal towns between Devonport and Wynyard. 12 Northwest Tasmania has two EDs, the North West Regional Hospital Correspondence: Dr Penny Allen, Rural Clinical School, University of Tasmania, Private Bag 3513, Hospitals’ Campus, Burnie, TAS 7320, Australia. Email: penny.allen @utas.edu.au Penny Allen, PhD, MPH, BA(Hons), Research Fellow; Colleen Cheek, RN, BSc, MIS, Research Fellow; Simon Foster, RN, GDPM, Clinical Senior Lecturer; Marielle Ruigrok, MBBS, FACEM, Emergency Staff Specialist; Deborah Wilson, MBBS, FANZCA, Associate Professor; Lizzi Shires, MBBS, FRCAGP, MFHPM, DRCOG, DCH, DLT, Associate Professor. Accepted 19 January 2015 Key findings • There was wide variation in the proportion of low acuity and GP- type presentations estimated by four different methods. • 15% to 69% of presentations were identified as GP-type patients. • Methods which rely on triage status and self-referral may be less reliable for identifying low acuity and GP-type patients in rural EDs. Emergency Medicine Australasia (2015) ••, ••–•• doi: 10.1111/1742-6723.12366 © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine