Trends and determinants of time spent in the emergency department among Australian hospital presenting self-harm cases

Aims: Waiting time (WT) and length of stay (LOS) are important metrics used to assess service delivery in emergency departments (EDs), and have been associated with subsequent re-presentations in EDs. This study investigated socio-demographic and health service determinants of WT and LOS among hospital treated self-harm (SH) cases presenting to EDs in Australian based hospitals.

Methods: This study employed a retrospective cohort study of all SH cases (N = 6203) presenting to public hospital EDs in the Western Sydney catchment area from January 2016 to December 2022. Cox proportional hazard models were used to analyse demographic and service factors related to WT and LOS in Australian hospitals along with a description of secular trends in WT and LOS.

Results: Longer WT was evident for patients aged 15-64 than 0-14 years, non-admitted patients and patients arriving at the ED via transport other than ambulance whereas longer LOS was associated with older patients (65+ years). The inflow of non-SH cases to the ED did not have an impact on WT or LOS among SH cases. WT and LOS increased over time, particularly post the onset of the COVID-19 pandemic. The number of current self-harm cases receiving treatment in ED at the time of patient's arrival also increased WT and LOS.

Conclusions: WT and LOS have increased, especially post the onset of the COVID-19 pandemic. These findings necessitate the urgent need for updated strategies to manage ED resources, and suggest initiatives relating to ED diversion where appropriate for patients presenting to hospital following SH.