'Dalarinji': A flexible clinic, belonging to and for the Aboriginal people, in an Australian emergency department.

ABSTRACT

OBJECTIVE: Equity and access to high-quality healthcare for Aboriginal and Torres Strait Islander (Aboriginal) people has remained refractory for complex and multifactorial reasons, and there are sound ethical arguments for addressing this urgently. In EDs all patients who 'leave at own risk' (LAOR) or 'do not wait to be seen' (DNW) are at increased risk of readmission, morbidity or death. This also incurs additional resource costs to the health system. Aboriginal patients have high rates of DNW and LAOR. The Flexiclinic model of care was co-designed to better support the needs of Aboriginal patients in the ED and to reduce the rates of DNW and LAOR. METHODS: 'Dalarinji', or Flexiclinic, is a flexible model of care within the ED collaboratively devised with the Aboriginal Health Unit to address the major factors that influence this vulnerable cohort leaving the St Vincent's Hospital ED (SVHED) prior to being assessed or before completion of treatment. RESULTS: In the 3 months since its introduction, the Flexiclinic approach has significantly improved the quality and equity of access to medical care at SVHED for Aboriginal patients with the average summed rate of DNW and LAOR falling to 5.2% of presentations, representing a fivefold decrease in the probability of Aboriginal patients receiving incomplete care. CONCLUSION: The Flexiclinic approach has significantly improved medical care at SVHED for Aboriginal patients. It has been well received by both staff and patients and has had no adverse effects on delivery of services to other patient groups.