Co-designing culturally safer emergency care Sandra Brownlea, staff specialist in the emergency department at Royal Darwin Hospital in Australia, identified inequitable and culturally unsafe care for frequent emergency department attenders, particularly Aboriginal and Torres Strait Islander patients. Social complexity was often addressed through a biomedical lens, leaving patients exposed to stigma and systemic racism. In 2023, attendance at the Healthcare Improvement Forum in Melbourne provided a practical framework to address these challenges. Plenary sessions and case studies on co-design, working with patients and the public, improving equity, and staff wellbeing showed how frontline clinicians can make practical changes to improve care and reduce avoidable emergency visits.
Building on these insights, Brownlea and colleagues secured Medical Research Future Fund support to pilot a culturally informed, patient centred case support programme. Led by an Aboriginal health practitioner and grounded in co-designed care plans, early results were promising: emergency department attendance at Royal Darwin Hospital fell by 50%; total admission bed days dropped from 27 to 9; and discharges against medical advice decreased from nine to one.
“Attending the Healthcare Improvement Forum gave me insight into the value of co-design methodology and involving consumers, and also the value of workforce wellbeing and how all of those things can intersect and improve outcomes.” Sandra Brownlea, Staff specialist, emergency department, Royal Darwin Hospital, Australia
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