The here and now
Access to emergency services
Outcome one // Effectiveness indicator
The Australasian College for Emergency Medicine (ACEM) developed the Australasian Triage Scale (ATS) to ensure that patients presenting to Emergency Departments (EDs) are medically assessed, prioritised according to their clinical urgency and treated in a timely manner.
This performance indicator measures the percentage of patients being assessed and treated within the required ATS timeframes. This provides an overall indication of the effectiveness of WA’s EDs, which can assist in driving improvements in patient access to emergency care.
ACEM targets for each ATS targets are outlined below:
| Triage category | Treatment acuity (maximum waiting time for medical assessment and treatment) | Target (threshold) |
| 1 | Immediate ≤ 2 minutes | 100% |
| 2 | ≤ 10 minutes | 80% |
| 3 | ≤ 30 minutes | 75% |
| 4 | ≤ 60 minutes | 70% |
| 5 | ≤ 120 minutes | 70% |
These recommended times and categories are used both locally by the WA Department of Health and nationally by the Department of Health and Ageing, and the Australian Institute of Health and Welfare.
2023-24 results
Triage category 1
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023-24 | Target 100% | Actual 98.3% |
|
| Years 2022-23 | Target | Actual 99.0% |
|
| Years 2021-22 | Target | Actual 99.6% |
|
| Years 2020-21 | Target | Actual 100% |
|
Triage category 2
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023-24 | Target 80.0% | Actual 71.7% |
|
| Years 2022-23 | Target | Actual 69.0% |
|
| Years 2021-22 | Target | Actual 68.0% |
|
| Years 2020-21 | Target | Actual 79.2% |
|
Triage category 3
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023-24 | Target 75.0% | Actual 18.8% |
|
| Years 2022-23 | Target | Actual 17.1% |
|
| Years 2021-22 | Target | Actual 18.8% |
|
| Years 2020-21 | Target | Actual 31.0% |
|
Triage category 4
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023-24 | Target 70.0% | Actual 37.3% |
|
| Years 2022-23 | Target | Actual 38.7% |
|
| Years 2021-22 | Target | Actual 41.5% |
|
| Years 2020-21 | Target | Actual 51.5% |
|
Triage category 5
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023-24 | Target 70.0% | Actual 72.4% |
|
| Years 2022-23 | Target | Actual 73.3% |
|
| Years 2021-22 | Target | Actual 78.1% |
|
| Years 2020-21 | Target | Actual 83.8% |
|
Period: 2020-21 to 2023-24 financial years
Contributing sites: Armadale Health Service, Royal Perth Hospital, St John of God Midland Public Hospital
Data source: Emergency Department Data Collection
EMHS performance against ATS category targets marginally increased in ATS categories 2 and 3 in 2023-24, but decreased in all other areas.
This year saw continued changes in the complexity and acuity of patient presentations, with a reduction in presentations for categories 4 and 5.
ATS category 1 saw a 6.8 per cent increase in presentations and subsequently recorded a slight decrease in performance.
Initiatives across EMHS have been successful in reducing unnecessary ED presentations from low acuity patients, reducing unnecessary demand in the ED and allowing patients to receive the care they need in a home environment.
Overall, EMHS ED presentations (for all ATS categories collectively) slightly decreased this financial year.
Ambulatory care
The ambulatory units at both Royal Perth Hospital (RPH) and St John of God Midland Public Hospital (SJGMPH) continue to provide important pathways to improve flow from EDs. These units divert suitable patients from the ED for same day assessment and management.
In 2023-24 the RPH ambulatory unit admitted almost 1,500 patients, 95 per cent of whom were transferred to the ambulatory unit within 6 hours of their presentation to ED. The majority of these patients were discharged directly from the ambulatory unit, allowing them to receive the care they need while recovering in their homes.
Community Health in a Virtual Environment (Co-HIVE)
The continued delivery of the Co-HIVE service model (click here for more information) has allowed for ongoing support for aged care residents, resulting in Emergency Department (ED) avoidance.
A new process of receiving referrals from the WA Virtual Emergency Department (WAVED) commenced in February 2024 and has further increased the rates of ED diversion for residential aged care patients.
Integration of Co-HIVE and the Royal Perth Hospital (RPH) ambulatory unit has allowed for patients to receive physical assessments outside of an ED and be followed up by the Co-HIVE supported discharge model.
In June 2024, several service activity milestones were met, including:
- supporting over 1,000 consumers
- facilitating over 1,200 episodes of care
- working with over 160 Residential Aged Care Facilities (RACFs)
- 106 virtual consultations (VCs) conducted – a 96 per cent increase from June 2023 (54 VCs).
Since implementation in November 2022, 929 patients have been part of the Supported Discharge Pathway (SDP), with a 28-day readmission rate of 8 per cent. Prior to the inception of Co-HIVE and the commencement of the SDP pathway, the readmission rate for patients aged over 65 years (discharged to a RACF) was 17 per cent (EMHS wide).
Vertical and horizontal streams
At St John of God Midland Public Hospital (SJGMPH), there has been a reconfiguration in the post-triage space.
Patients are streamed into ‘vertical’ or ‘horizontal’ streams, with vertical patients placed in chairs instead of cubicles and stretchers.
An area was converted to a vertical wait room, and there is an allocation of ED bays for vertical patients. This has helped expedite the processing of patients who are likely to be discharged from the ED directly.
Armadale Health Service discharge lounge
In 2023-24, Armadale Health Service (AHS) discharge lounge utilisation increased by an impressive 56 per cent (since commencement in June 2023). Greater use of the discharge lounge has enabled beds to be available earlier in the day (with a focus on moving patients before 10am), reducing access block when transferring patients from ED to the wards.
Initiatives such as increasing discharge lounge utilisation have led to positive impacts on ED performance, with ambulance Transfer of Care improving by 15 per cent in 2023-24 compared to the prior reporting period.
Mental Health related challenges
An increase in people presenting to our EDs with mental health issues, in combination with ongoing shortages in the mental health workforce, represents a growing challenge for emergency access.
Despite increasing mental health presentations at RPH in particular, good performance has been maintained, with median length of episode for admitted and non-admitted mental health services remaining relatively low.
EMHS ED attendances per month
