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Research - DESTINY

Research Project Overview

Demand for Emergency Service Trends IN Years 2010-14 (DESTINY10.14): A population based study of Emergency Department utilisation and length of stay in New South Wales


Managing access and demand remains one of the fundamental challenges of modern emergency medicine (1). Understanding it at a population level allows better choices in the allocation of finite health resources, and provides a basis for which emergency department best practice models of care can be developed and improved across the state.

Previous studies have demonstrated an increased demand for emergency department care across Australia over the past decade (2). A major factor driving this trend is thought to be the ageing population across Australia (3). A preliminary study of data from 2001-2011 performed by the principal author, Michael Dinh using the Emergency Department Data Collection Registry (see below) showed not only an increase in overall ED presentation rates but a disproportionate increase in presentations for those aged 80 years and over. A similar study undertaken in metropolitan Melbourne from 1999-2009 showed age specific presentation rates highest in the elderly (4,5) However the type of presenting problem and re-presentation rates were not studied in that study.
The last in-depth analysis of ED demand in NSW was commissioned in 2006 and was a hypothesis driven analysis of supply and demand factors based on activity in 2004-06 (6). It concluded that the increase in demand seen in 2005-6 was multi-factorial with the main drivers being “primary care presentations” and an increase in chronic illness. Therefore there is a critical need further understand the drivers of ED demand at a population level.


M.M. Dinh, et al., Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: Implications for major injury surveillance and trauma systems, Injury (2016),

Berendsen Russell, S., Dinh, M.M. & Bell, N. (2016) Triage, damned triage. . . and statistics: Sorting out redundancy and duplication within an Emergency Department Presenting Problem Code Set to enhance research capacity. Australasian Emergency Nursing Journal 20 (2017) 48–52

Dinh MM, Berendsen Russell S, Bein KJ, et al. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?. BMJ Open 2016; 6:e010964. doi:10.1136/bmjopen-2015-010964

Michael M. Dinh MB, BS, MPH, Sandy Muecke PhD, Saartje Berendsen Russell BN, Dane Chalkley MB, BS, Kendall J. Bein MB, MS, David Muscatello PhD, Guruprasad Nagaraj MB, BS, Richard Paoloni MB, BS, MClinEpi & Rebecca Ivers MPH, PhD (2016): Demand for Emergency Services Trends in New South Wales Years 2010–2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments, Prehospital Emergency Care, DOI: 10.1080/10903127.2016.1182603

Dinh, M.M., et al. (2016) The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective statewide data from New South Wales, Australia. BMC Emergency Medicine (2016) 16:46
DOI 10.1186/s12873-016-0111-4

Dinh, M.M., et al. (2016) Trends and characteristics of short-term and frequent representations to emergency departments: A population-based study from New South Wales, Australia. Emergency Medicine Australasia (2016) 28, 307–312

Bein, K.J., et al. (2017) Feeling the HEAT: Using Hourly Emergency Activity Tracking to demonstrate a novel method of describing activity and patient flow. Emergency Medicine Australasia (2017) 29, 173–177

Further References and Resources

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