Admitted patient care: overview

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 2010–11:

• about 8.9 million separations took place in Australian hospitals (Table 4)
• public hospitals accounted for 60% of separations (5.3 million), with half of these being same-day separations
• the proportion of the total that was in public hospitals ranged from 53% in Queensland to 63% in Victoria
• private hospitals accounted for 40% of separations (3.6 million), with about two-thirds of these being same-day separations (Figure 14)
• most patient days occurred in public hospitals, ranging from 61% in Queensland to 73% in New South Wales (Table 5).

Figure 14: Same-day and overnight separations, public and private hospitals, 2010–11

 

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How has this activity changed over time?

Between 2006–07 and 2010–11, separations increased by 16.7% overall (13.3% in public acute hospitals and 21.5% in private hospitals). This was an average increase of 3.9% per year (Figure 15).

The number of patient days in public acute hospitals increased by 6.3%. For private hospitals, patient days increased by 12.3%.

The numbers of patient days per 1,000 population were relatively stable for private hospitals between 2006–07 and 2010–11 and decreased slightly for public hospitals. Between 2009–10 and 2010–11, separations increased overall by 3.8% (4.2% in public hospitals and 3.2% in private hospitals). Patient days increased by 2.0% overall, by 2.1% in public hospitals and 1.8% in private hospitals. After adjusting for some coverage changes, separations increased by 4.1% in public hospitals and 3.9% in private hospitals.

Figure 15: Separations and patient days, public acute and private hospitals, 2006–07 to 2010–11

Who used these services?

In 2010–11, there were over 4.6 million separations for women and girls compared with 4.2 million separations for men and boys (52.4% and 47.6% of separations respectively) (Figure 16).  People aged 65 and over accounted for 38% of separations and 48% of patient days.

Separations increased for both males and females between 2006–07 and 2010–11. These increases were very marked for both men and women aged 55 and over (Figure 17).

For persons aged 85 and over, there was an overall increase of 41% in separations between 2006–07 and 2010–11, an average increase of 9% each year.

Figure 16: Separations, by age group and sex, all hospitals, 2010–11

 

Figure 17: Change in the number of separations, by age group and sex, all hospitals, 2006–07 to 2010–11

 

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 under-identification.

In 2010–11:

• Indigenous Australians had a separation rate about two and a half times the separation rate for other Australians (911 per 1,000 population compared with 366 per 1,000 population).
• Indigenous Australians had more separations per 1,000 population than other Australians across all age groups (Figure 18).

However, if hospitalisations for dialysis for kidney disease are not counted, Indigenous Australians were hospitalised only about 30% more often than other Australians (425 per 1,000 population compared with 311 per 1,000). This illustrates the impact of kidney disease on the health of Indigenous Australians, and the subsequent hospital usage for dialysis.

Figure 18: Separations per 1,000 population, by Indigenous status and age group, all hospitals, 2010–11

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 19).

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 (512 and 210 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 (170 and 62 separations per 1,000 population respectively).

Figure 19: Separations per 1,000 population, by remoteness area of usual residence, public and private hospitals, 2010–11

 

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 per 1,000 population 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 20).

For public hospitals, the separation rate 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 (293 and 147 separations per 1,000 population, respectively).

For private hospitals, the separation rate 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 99 separations per 1,000 population, respectively).

Figure 20: Separations per 1,000 population, by socioeconomic status of area of usual residence, public and private hospitals, 2010-11

 

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, for example, an injury caused by 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 2010–11, many separations had a principal diagnosis reported that was a disease of the digestive system (10.0%), a cancer (6.6%), an injury or poisoning (6.5%), a disease of the circulatory system (5.8%), a condition associated with pregnancy and childbirth (5.4%) or a disease of the musculoskeletal system (5.4%).

Some high-volume diagnoses experienced relatively large changes in volume between 2006–07 and 2010–11 in either public or private hospitals, or both (Figure 21). For example, separations for care involving dialysis increased by 23% in public hospitals (to 974,000, an average annual increase of 5.3%) and by 44% in private hospitals (to 210,000, an average annual increase of 9.6%). Separations for cataracts increased by 43% in public hospitals (to 56,000) and by 48% in private hospitals (to 114,000).

Figure 21: Change in number of separations for selected principal diagnoses, public and private hospitals, 2006–07 to 2010–11

 

In 2010–11, injury and poisoning was the principal diagnosis for over 580,000 separations in Australian hospitals. Commonly reported external causes of injury and poisoning included falls (191,000), complications of medical and surgical care (121,000), transport accidents (58,000), intentional self-harm (28,000) and accidental poisoning (10,000) (Figure 22).

Figure 22: Injury and poisoning separations, by cause, all hospitals, 2010–11

 

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 646,000 PPHs represented 7.3% of all hospital separations in 2010–11.

Overall, the number of PPHs per 1,000 population decreased by an average of 3.9% per year between 2006–07 and 2010–11, and decreased by 7.8% between 2009–10 and 2010–11. However, changes in how diabetes-related conditions were reported over this period were probably responsible for the majority of these decreases. The number of diagnoses reported for diabetes and impaired glucose regulation (E09–E14) decreased from almost 903,000 in 2007–08 to about 330,000 in 2010–11. Acute preventable conditions increased by an average of 7.0% per year between 2006–07 and 2010–11, and vaccine preventable conditions were relatively stable. Chronic conditions other than diabetes decreased by 0.4%.

For chronic conditions, excluding diabetes, PPHs rose with increasing remoteness in 2010–11. There were 8.9 PPHs per 1,000 population for chronic conditions in Major cities, and 20.0 per 1,000 in Very remote areas (Figure 23).

For acute conditions, the pattern was the same, ranging from 13.2 per 1,000 in Major cities to 29.2 per 1,000 in Very remote areas.

Figure 23: Potentially preventable hospitalisations by remoteness area of usual residence, all hospitals, 2010–11

 

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 (1.0 and 0.6 per 1,000, 16.0 and 11.9 per 1,000, and 17.2 and 8.4 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—70% in 2010–11, and 4% were for childbirth (Figure 24). About 21% of overnight separations were for surgical care, as were 14% of same-day separations.

Figure 24: Same-day and overnight separations, by broad category of service, public hospitals, 2010–11

 

More information on broad categories of service for public hospitals for each state and territory is presented in Figures 24a–24h, below.

Figure 24a: Same-day and overnight separations, by broad category of service, public hospitals, NSW 2010–11

 

Figure 24b: Same-day and overnight separations, by broad category of service, public hospitals, Vic 2010–11

 

Figure 24c: Same-day and overnight separations, by broad category of service, public hospitals, Qld 2010–11

 

Figure 24d: Same-day and overnight separations, by broad category of service, public hospitals, WA 2010–11

 

Figure 24e: Same-day and overnight separations, by broad category of service, public hospitals, SA 2010–11

 

Figure 24f: Same-day and overnight separations, by broad category of service, public hospitals, Tas 2010–11

 

Figure 24g: Same-day and overnight separations, by broad category of service, public hospitals, ACT 2010–11

 

Figure 24h: Same-day and overnight separations, by broad category of service, public hospitals, NT 2010–11

 

Private hospitals provided a higher proportion of separations for surgical care compared with public hospitals—37% in 2010–11. Specialist mental health care was provided for 4% of private hospital separations (Figure 25).

Figure 25: Same-day and overnight separations, by broad category of service, private hospitals, 2010–11

 

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 2010–11 for 96% of separations and 78% of patient days for public hospitals and for 93% of separations and 83% of patient days for private hospitals.

Rehabilitation, or improved functioning, was the next most commonly reported intent of care. For 2010–11, it was reported for 1.6% of separations and 7.9% of patient days for public hospitals and for 5.6% of separations and 11.2% of patient days for private hospitals. For more information see Admitted patient care: sub-acute and 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 2010–11, one or more procedures were reported for 82% of separations in Australian hospitals. Over 94% of separations from private hospitals recorded a procedure, compared with 73% from public hospitals. Overall, 54% of separations that reported a procedure occurred in the public sector.

In 2010–11, 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 (3.2%). Also commonly reported were separations with non-invasive, cognitive and other interventions, including allied health and general anaesthesia (61.1%).

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: falls resulting in patient harm in hospitals

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

For more information see: Hospital performance: Staphylococcus aureus bacteraemia (SAB) in Australian public 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 3.0 days in 2010–11, 2.4 days in private hospitals and 3.4 days in public acute hospitals. These averages have decreased over time (Figure 29), largely reflecting the fact that the proportion of separations that are day-only have increased.

Figure 29: Average length of stay, public acute and private hospitals, 2001–02 to 2010–11

 

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 3.0 days in public hospitals and 2.2 days in private hospitals (Figure 30). For Rehabilitation care, the average length of stay was 17.4 days in public hospitals and 4.8 days in private hospitals.

Figure 30: Average length of stay (days) by care type, public and private hospitals, 2010–11

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 2010–11 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 34).

Figure 34: Proportion of separations by principal source of funds, all hospitals, 2010–11

 

Between 2006–07 and 2010–11, there was an overall increase in separations of 3.9% per year. Separations funded by motor vehicle third party personal claims increased by 7.3% per year and those funded by private health insurance increased by 5.6% per year (Figure 35).

Figure 35: Average annual change in the number of separations by selected principal source of funds, all hospitals, 2006–07 to 2010–11

 

Information is also available for:

• Admitted patient care: same-day acute care
• Admitted patient care: overnight acute care
• Admitted patient care: elective surgery
• Admitted patient care: sub-acute and non-acute care