Dalarinji; Justifying a Flexible Approach to Aboriginal Healthcare in the Emergency Department.

Dr Paul Preisz1,2, Ms Anne Preisz2,3

1University of NSW, Randwick, Australia, 2University of Notre Dame Australia, Darlinghurst, Australia, 3Sydney Health Ethics, U.Syd, Camperdown, Australia

Program stream: Research ethics (or possibly health law?)

Equity and access to high quality healthcare for Aboriginal and Torres Strait Islander people has remained refractory for complex and multifactorial reasons and addressing this urgently is ethically obligatory

In Emergency Departments patients who “leave at own risk” (LAOR) or “do not wait to be seen” (DNW) are at increased risk of readmission, increased morbidity or death. This also incurs additional resource costs to the health system. Aboriginal patients have high rates of DNW and LAOR.


‘Dalarinji’  (Ours, belonging to us) or Flexiclinic was designed to better address the needs of Aboriginal patients in the Emergency Department and to reduce the rates of DNW and LAOR.


‘Dalarinji’ is a flexible model of care within the ED collaboratively devised with the Aboriginal Liaison Unit to tackle the major factors that influence this vulnerable cohort leaving the St Vincent’s Hospital Emergency Department (SVHED) prior to being assessed or before completing treatment.


In the twelve months since its introduction, the Flexiclinic approach has significantly improved the quality and equity of access to medical care at SVHED for Aboriginal patients. The average rate has fallen from greater than 25% to 5.2% of presentations, representing a five-fold decrease in the odds of patients receiving incomplete care.


This model has significantly improved medical care and outcomes at SVHED for Aboriginal patients. A tailored restructuring of service provision was ethically justified to support the needs of this previously underserved cohort. All stake-holders were involved from inception to reflect on the ethical rationale for a flexible model and this was integral to its successful implementation.


Paul Preisz is the Medical Director of the Emergency Department at St Vincent’s Hospital Sydney, Associate Professor of Emergency and Critical Care Medicine, University of Notre Dame and Senior Lecturer at the UNSW

He is committed to improving emergency care for vulnerable patients, including Aboriginal people and  patients with issues related to mental health, drugs and alcohol, homelessness and social disadvantage

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