Emergency department triage of indigenous and non-indigenous patients in tropical Australia

Abstract

Objective: To examine the relationship between ethnicity and triage at a tertiary hospital emergency department. Methods: Electronic Emergency Department Information System data analysis was used to examine the relationship between ethnicity and triage allocation and process times between 1 April 1999 and 29 June 1999. Outcome measures were waiting times by triage category and admission rate by triage category. Results: There were 9614 attendances: 1949 indigenous (20.3%), 7328 non-indigenous (76.2%) and 337 (3.5%) had no ethnicity recorded. Indigenous patients were more often female (1033; 53%, CI 51-55%) than non-indigenous patients (3078; 42.0%, CI 41-43%, P < 0.001). Indigenous patients presented more often with illness (70% CI 68-72%) rather than injury (30%, CI 28-32%), compared with the non-indigenous patients, illness (64%, CI 63-65%), injury (36%, CI 35-37%, P < 0.001). Indigenous patients were more likely to be triaged to national triage scale categories 1, 2 or 3 (36%, CI 34-38%) than non-indigenous patients (32%, CI 31-33%, P = 0.011). Admission rates for indigenous patients were higher than non-indigenous patients across all urgency categories and were within national triage scale guidelines. Non-indigenous admission rates were well below national triage scale guidelines for all urgency categories. The overall admission rate for indigenous patients was double (33%, CI 31-35%) that for non-indigenous patients (16%, CI 15-17%, P < 0.001). There was no significant difference between indigenous and non-indigenous waiting times. Conclusion: Indigenous patients are more likely to present with illness rather than injury and are more likely to require admission than non-indigenous patients. Indigenous patients are triaged in accordance with Australasian triage guidelines. Many non-indigenous patients should be triaged to lower urgency categories to allow resource allocation towards higher acuity indigenous and non-indigenous patients.