Admitted patient care: overview (AIHW)

This overview presents information on all admitted patient care. Information is also available for:

Admission to hospital is a formal process, and follows a medical officer making a decision that a patient needs to be admitted for appropriate management or treatment of their condition, or for appropriate care or assessment of their needs.

Separations (episodes of admitted patient care) and patient days (a count of the days spent in hospital as an admitted patient) are useful measures of admitted patient services.

In 2009–10:

about 8.5 million separations took place in Australian hospitals
public hospitals (5.1 million separations) accounted for 60% of separations, with half of these being same-day separations
the proportion of the total that was in public hospitals ranged from 52% in Queensland to 62% in both New South Wales and Victoria
private hospitals (3.5 million) accounted for 40% of separations, with two-thirds of these being same-day separations (Figure 15)
and most patient days occurred in public hospitals, ranging from 60% in Queensland to 73% in New South Wales (Table 5).

Figure 15: Same-day and overnight separations, public and private hospitals, 2009-10

**Table 4: Separations ('000s), public and private hospitals, states and territories, 2009-10**
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total
Public hospitals
Public acute	1,541	1,424	923	504	381	101	88	100	5,062
Public psychiatric	6	1	<1	2	2	1	. .	. .	11
Total public hospitals	1,547	1,425	923	506	383	102	88	100	5,073
Private hospitals
Private free-standing day hospital facilities	213	188	213	104	57	n.p.	n.p.	n.p.	783
Other private hospitals	748	697	632	278	213	n.p.	n.p.	n.p.	2,678
Total private hospitals	961	886	845	381	270	n.p.	n.p.	n.p.	3,462
All hospitals	2,508	2,310	1,768	887	653	n.p.	n.p.	n.p.	8,535

n.p.—not published
. . not applicable

**Table 5: Patient days ('000s), public and private hospitals, states and territories, 2009-10**
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total
Public hospitals
Public acute	5,816	4,547	3,030	1,647	1,495	372	296	273	17,476
Public psychiatric	281	59	98	76	97	52	. .	. .	663
Total public hospitals	6,097	4,607	3,128	1,722	1,591	424	296	273	18,139
Private hospitals
Private free-standing day hospital facilities	213	188	213	104	57	n.p.	n.p.	n.p.	783
Other private hospitals	2,012	2,047	1,850	726	560	n.p.	n.p.	n.p.	7,497
Total private hospitals	2,225	2,235	2,063	829	617	n.p.	n.p.	n.p.	8,262
All hospitals	8,323	6,842	5,191	2,552	2,209	n.p.	n.p.	n.p.	26,401

n.p.—not published
. . not applicable

How has this activity changed over time?

Between 2005–06 and 2009–10 separations increased by 16.7% (13.6% in public acute hospitals and 21.6% in private hospitals) (Figure 16).

The number of patient days in public acute hospitals increased by 6.7%. For private hospitals, patient days increased by 12.6%.

The numbers of patient days per 1,000 population were relatively stable for both public and private hospitals between 2005–06 and 2009–10.

Figure 16: Separations and patient days, public acute and private hospitals, 2005-06 to 2009-10

Who used these services?

In 2009-10, there were over 4.5 million separations for women and girls compared with 4.1 million separations for men and boys (52.6% and 47.4% of separations respectively) (Figure 17).

Separations increased for both males and females between 2005-06 and 2009-10. These increases were very marked for both males and females aged 55 and over (Figure 18).

Most notably, separations increased by 49% for males and by 33% for females aged 85 years and over.

Figure 17: Separations, by age group and sex, 2009-10

Figure 18: Change in the number of separations, by age group and sex, Australia, 2005-06 to 2009-10

Aboriginal and Torres Strait Islander people

Aboriginal and Torres Strait Islander people are hospitalised more often than other Australians (after accounting for age). Information on the number of hospitalisations for Indigenous people is limited by the accuracy with which Indigenous patients are identified in hospital records and the rates may be underestimates. The numbers here are not adjusted for underidentification.

In 2009-10:

Indigenous Australians had a separation rate almost two and a half times the separation rate for other Australians (898 per 1,000 population compared with 370 per 1,000 population).
Indigenous Australians had more separations per 1,000 population than other Australians across all age groups (Figure 19).

However, if hospitalisations for dialysis for kidney disease are not counted, Indigenous Australians were hospitalised about 30% more often (433 per 1,000 population compared with 328 per 1,000). This illustrates the impact of kidney disease on the health of Indigenous Australians, and their subsequent hospital usage for dialysis.

Figure 19: Separations per 1,000 population, by Indigenous status and age group, 2009-10

Remoteness

Locations in Australia can be divided into remoteness area categories, depending on distances from population centres.

The number of separations per 1,000 population varied by remoteness area. Overall, separation rates were highest for persons living in Very remote areas (Figure 20).

For public hospitals, the number of separations per 1,000 population was highest for patients living in Very remote areas and lowest for patients living in Major cities (482 and 206 separations per 1,000 population, respectively).

For private hospitals, the separation rate was highest for patients living in Major cities and lowest for patients living in Very remote areas (169 and 58 separations per 1,000 population respectively).

Figure 20: Separations per 1,000 population, by remoteness area of usual residence, public and private hospitals, 2009-10

Socioeconomic status

Data describing where patients live can be used to derive an approximation of their socioeconomic status (SES), which in turn can be categorised into five equal population groups of socioeconomic disadvantage/advantage. If use of admitted patient services is equal for all SES groups, we would expect an equal number of separations for each group.

The number of separations varied by SES group. Overall, separation rates were highest in the lowest SES group, but there was little variation across the other 4 SES groups (Figure 21).

For public hospitals, the number of separations was highest for patients living in areas classified as being the lowest SES group and lowest for patients living in areas classified as being the highest SES group (291 and 146 separations per 1,000 population, respectively).

For private hospitals, the number of separations was highest for patients living in areas classified as being the highest SES group and lowest for patients living in areas classified as being the lowest SES group (221 and 102 separations per 1,000 population, respectively).

Figure 21: Separations per 1,000 population, by socioeconomic status group, public and private hospitals, 2009-10

Why did people receive this care?

The reason that a patient receives admitted patient care can be described in terms of a principal diagnosis. For injury and poisoning, it can also be described in terms of the cause of the injury, for example, a traffic accident or fall. For other types of care, it can be described in terms of a treatment for an ongoing condition (for example, dialysis for kidney failure).

In 2009–10, many separations had a principal diagnosis reported that was a disease of the digestive system (10.2%), a cancer (6.8%), an injury or poisoning (6.8%), a disease of the circulatory system (5.7%), a condition associated with pregnancy and childbirth (5.6%), a disease of the respiratory system (4.4%), or a mental disorder (4.0%).

Some high-volume diagnoses have experienced relatively large changes in volume between 2005–06 and 2009–10 in either public or private hospitals or both (Figure 22). For example, separations for care involving dialysis increased by 26% in public hospitals (to 931,000) and 31% in private hospitals (to 200,000). Separations for angina pectoris decreased by 16% in public hospitals (to 46,000) and by 14% in private hospitals (to 19,000).

Figure 22: Change in number of separations for selected principal diagnoses, public and private hospitals, 2005-06 to 2009-10

In 2009–10, injury and poisoning was the principal diagnosis for over 557,000 separations in Australian hospitals. External causes of injury and poisoning commonly reported included falls (178,000), complications of medical and surgical care (115,000), transport accidents (59,000), intentional self-harm (28,000) and accidental poisoning (10,000) (Figure 23).

Figure 23: Injury and poisoning separations, by cause, 2009-10

Potentially preventable hospitalisations

The selected potentially preventable hospitalisations (PPHs) presented here are thought to have been avoidable if timely and adequate non-hospital care had been provided, either to prevent the condition occurring, or to prevent the hospitalisation for the condition. They are identified based on the diagnoses reported for admitted patients and divided into three categories—vaccine-preventable, acute and chronic conditions.

The 696,000 PPHs represented 8.1% of all hospital separations in 2009–10.

Overall, the number of PPHs per 1,000 population decreased by an average of 1.6% per year between 2005–06 and 2009–10, and decreased by 1.7% between 2008–09 and 2009–10. However, this latest decrease is likely to reflect a change in how diabetes-related conditions were reported.

For chronic conditions, without diabetes, PPHs rose with increasing remoteness. There were 8.8 PPHs for chronic conditions per 1,000 population in Major cities, and 19.0 per 1,000 in Very remote areas (Figure 24).

For acute conditions, the pattern was the same, ranging from 12.9 per 1,000 in Major cities to 29.2 per 1,000 in Very remote areas.

Figure 24: Potentially preventable hospitalisations by remoteness area of usual residence, 2009-10

The number of PPHs per 1,000 population varied with socioeconomic status (based on where patients live). For all three categories—vaccine-preventable, acute and chronic—the rates were highest for those classified as being in the lowest SES group and lowest for those classified as being in the highest SES group (1.1 and 0.6 per 1,000, 16.0 and 11.7 per 1,000, and 20.8 and 10.7 per 1,000, respectively).

How urgent was the care?

Admissions can be categorised as Emergency (required within 24 hours), or Elective (required at some stage beyond 24 hours). Emergency/elective status is not assigned for some admissions (for example, obstetric care and planned care, such as dialysis).

For public hospitals, 2 out of 5 separations were Emergency admissions. For private hospitals, about 1 in 20 separations were Emergency admissions.

What care was provided?

The care that is provided can be described in terms of the:

broad category of service—Childbirth, Specialist mental health, Medical (not involving a procedure), Surgical (involving an operating room procedure), or Other (involving a non-operating room procedure, such as endoscopy)
intent of care—acute, sub-acute (such as rehabilitation or palliative), or non-acute (such as maintenance care)
type of surgical or other procedure undertaken.

Broad category of service

In public hospitals, most separations were for Medical care—76% in 2009–10 and 4% were for Childbirth (Figure 25). About 21% of overnight separations were for Surgical care, as were 14% of same-day separations.

Figure 25: Same-day and overnight separations, by broad category of service, public hospitals, 2009-10

More information on broad categories of service for public hospitals for each state and territory is presented in figures 25a-25h below.

**Figures 25a-25h: Same-day and overnight separations, by broad category of service, public hospitals, 2009–10 <*select thumbnail below for full size image*>**
Figure 25a: NSW	Figure 25b: Vic	Figure 25c: Qld	Figure 25d: WA
Figure 25e: SA	Figure 25f: Tas	Figure 25g: ACT	Figure 25h: NT

Private hospitals provided a higher proportion of separations for Surgical care compared with public hospitals—41% in 2009–10. Specialist mental health care was provided for 4% of private hospital separations (Figure 26).

Figure 26: Same-day and overnight separations, by broad category of service, private hospitals, 2009-10

Intent of care

Most hospital separations are for acute care, that is, care with the intent to cure the condition, alleviate symptoms or manage childbirth. Acute care was reported in 2009-10 for 95% of separations and 80% of patient days for public hospitals and for 94% of separations and 86% of patient days for private hospitals.

Rehabilitation, or improved functioning, was the next most commonly reported intent of care. It was reported for 2009–10 for 1.6% of separations and 8.3% of patient days for public hospitals and for 4.9% of separations and 10.6% of patient days for private hospitals. For more information see: non-acute care.

Procedures

Procedures can be surgical or non-surgical, can be used to treat or diagnose a condition, or be of a patient support nature, such as anaesthesia.

In 2009-10, one or more procedures were reported for 83% of separations in Australian hospitals.

Over 94% of separations from private hospitals recorded a procedure, compared with 77% from public hospitals. Overall, 55% of separations that reported a procedure occurred in the public sector.

In 2009–10, many separations had a procedure reported that was on the urinary system (16.3%), the digestive system (13.4%), the musculoskeletal system (6.6%) or the cardiovascular system (3.8%). Also commonly reported were separations with imaging services (8.0%) and separations with non-invasive, cognitive and other interventions, including allied health and general anaesthesia (61.2%).

For more information see: Hospital performance: rates of service—hospital procedures

What was the safety and quality of the care?

Some information is available on the safety and quality of admitted patient care in hospitals, but the available information does not provide a complete picture. There is no routinely available information on some aspects of quality, such as continuity or responsiveness of hospital services.

For more information see: Hospital performance: staphylococcus aureus bacteraemia (SAB) in Australian public hospitals

For more information see: Hospital performance: readmissions following surgery

For more information see: Hospital performance: falls resulting in patient harm in hospitals

For more information see: Hospital performance: intentional self-harm in hospitals

How long did patients stay?

Information on the average length of stay summarises how long admitted patients stay in hospital.

Including both same-day care (which is counted as one day’s stay, even if it is only for a few hours) and overnight care (care that is for at least one night), the average length of stay was 3.1 days in 2009–10, 2.4 days in private hospitals and 3.4 days in public acute hospitals. These averages have decreased over time (Figure 30), largely reflecting the fact that the proportion of separations that are day-only have increased.

Figure 30: Average length of stay, public acute and private hospitals, 2000–2001 to 2009–10

For overnight care, the average length of stay varied according to the intent of the care. For example, the average length of stay for Acute care was 3.1 days in public hospitals and 2.2 days in private hospitals (Figure 31). For Rehabilitation care, the average length of stay was 18.4 days in public hospitals and 5.2 days in private hospitals.

Figure 31: Average length of stay (days) by care type, public and private hospitals, 2009–10

For more information see: Hospital performance: relative stay index

For more information see: Hospital performance: average length of stay for selected types of separations

How much did it cost?

We have information on average costs for public hospitals, but not for private hospitals. The cost of care (expenditure by the hospital) varies according to the length of stay, procedures undertaken and the care needs of the patient.

For more information see: Hospital performance: cost per casemix-adjusted separation

Who paid for the care?

Over half of all separations in 2009–10 were public patients (52%), who were not charged for their stay. Private health insurance accounted for a further 38%, and self-funded patients and Department of Veterans’ Affairs patients accounted for about 4% each (Figure 35).

Figure 35: Proportion of separations by principal source of funds, 2009–10

Between 2005–06 and 2009–10, there was an overall increase in separations of 3.9% per year. Separations funded by private health insurance increased by more than the overall increase (6.4% per year) (Figure 36).

Figure 36: Average annual change in the number of separations by selected principal source of funds, 2005–06 to 2009–10

Information is also available for:

Admitted patient care: overview