Strengthening emergency department to community partnerships: qualitative insights from four local health districts in New South Wales

Purpose The compounded disadvantage for individuals with unmet social and health care needs often leads to frequent emergency presentations. In Australia, New South Wales, the Emergency Department to Community (EDC) program was devised to support intensive care coordination for patients with complex care. With a lack of qualitative evidence, the aim of this study was to explore the barriers and facilitators of forming, implementing and sustaining partnerships with EDC stakeholders in four local health districts: Sydney, Central Coast, South Eastern Sydney and Murrumbidgee. Design/methodology/approach Data collection (March–July 2025) comprised documentary analyses of EDC documentation and interviews and focus groups with stakeholders, the allied workforce and community providers. Approvals were obtained, all data were de-identified and data saturation was achieved. Thematic analysis was undertaken pragmatically within the School of Strauss and Corbin. An adapted version of Wodchis's policy framework was applied to assess subtheme alignment and sustainability of EDC partnerships. Triangulation between data sources was undertaken, and a roundtable was held to verify findings. Governance was provided by a steering committee with representatives from LHDs. Findings In total, 48 documents and 53 interview/focus group data were analysed. Four key themes are described: EDC patients have diverse complex needs and deep mistrust in the system. Multidisciplinary working and collaboration through cross-sectoral meetings, emergency department (ED) management plans and technological systems helped break silos and connect care across settings. Hidden work, which is not captured in data metrics, was often led by program champions and generalists that build rapport and bridge gaps in care coordination with multiple specialists. The impact of EDC was consistently echoed as “great” with staff satisfaction and a perceived reduction in ED presentations. Originality/value The EDC program delivers trauma-informed care for people with complex needs who are excluded from standard care models. Hidden labour and generalists are critical in building connections and rapport with specialists across health and social sectors. The program’s policy and social impacts align with equity, supporting the quintuple aim and sustainable development goals by prioritising support for the most disadvantaged groups.