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 2011–12:

• about 9.3 million separations took place in Australian hospitals (Table 4)
• public hospitals accounted for 60% of separations (5.5 million), and half of these were 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 (3.7 million), and about two-thirds of these were 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).

Table 4: Separations ('000s), public and private hospitals, states and territories, 2011–12

	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total
Public hospitals
Public acute	1,655	1,543	1,001	587	405	99	97	113	5,502
Public psychiatric	5	<1	<1	1	2	<1	. .	. .	10
Total public hospitals	1,661	1,544	1,001	588	407	100	97	113	5,511
Private hospitals
Private free-standing day hospitals	226	209	212	120	65	n.p.	n.p.	n.p.	844
Other private hospitals	845	708	689	316	225	n.p.	n.p.	n.p.	2,901
Total private hospitals	1,070	918	901	436	290	n.p.	n.p.	n.p.	3,745
All hospitals	2,731	2,462	1,902	1,024	697	n.p.	n.p.	n.p.	9,256

n.p. not published
. . not applicable

Table 5: Patient days ('000s), public and private hospitals, states and territories, 2011–12

	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Total
Public hospitals
Public acute	6,130	4,742	3,116	1,795	1,560	348	327	294	18,313
Public psychiatric	305	40	147	61	119	5	. .	. .	678
Total public hospitals	6,435	4,782	3,263	1,857	1,679	354	327	294	18,991
Private hospitals
Private free-standing day hospitals	226	209	212	120	65	n.p.	n.p.	n.p.	844
Other private hospitals	2,227	2,052	1,965	785	569	n.p.	n.p.	n.p.	7,901
Total private hospitals	2,453	2,262	2,177	906	634	n.p.	n.p.	n.p.	8,745
All hospitals	8,888	7,044	5,440	2,762	2,313	n.p.	n.p.	n.p.	27,736

n.p. not published
. . not applicable

How has this activity changed over time?

Between 2007–08 and 2011–12, separations increased by 17.6% overall. This was an average increase of 4.1% per year (3.8% in public acute hospitals and 4.6% in private hospitals) (Figure 15).

Over the same period, the number of patient days increased at a slower rate than separations, reflecting an increase in same-day admissions. Patient days increased by 1.5% per year for public hospitals and by 2.9% per year for private hospitals.

Between 2010–11 and 2011–12, separations increased overall by 4.6% (4.4% in public hospitals and 4.8% in private hospitals). Patient days increased by 2.4% in public hospitals and 4.0% in private hospitals.

Who used these services?

In 2011–12, there were almost 4.9 million separations for women and girls compared with 4.4 million for men and boys (52% and 48% of separations, respectively) (Figure 16). People aged 65 and over accounted for 39% of separations and 48% of patient days.

Separations increased for both males and females between 2007–08 and 2011–12. 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 40% in separations between 2007–08 and 2011–12, an average increase of 9% each year.

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 2011–12:

• Indigenous Australians had a separation rate more than two and a half times the separation rate for other Australians (973 per 1,000 population compared with 385 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 33% more often than other Australians (451 per 1,000 population compared with 340 per 1,000). This illustrates the impact kidney disease has on the health of Indigenous Australians, and the subsequent hospital usage for dialysis.

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 (524 and 216 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 (175 and 70 separations per 1,000 population, respectively).

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.

Overall, there was little variation across the SES groups in the number of separations per 1,000 population (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 (305 and 152 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 (227 and 103 separations per 1,000 population, respectively).

Why did people receive this care?

The reason that a patient receives admitted patient care can be described in terms of a principal diagnosis. Sometimes it is described in terms of a treatment for an ongoing condition (for example, dialysis for kidney failure).

In 2011–12, for public and private hospitals combined, about 27% of separations had a principal diagnosis in the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) chapter Factors influencing health status and contact with health services, which includes dialysis, chemotherapy and rehabilitation.

The 10 principal diagnosis chapters presented in Figure 21 accounted for a further 52% of public hospital separations and 61% of private hospital separations. 

Many separations had a principal diagnosis reported that was a disease of the digestive system (10%), a cancer (6%), an injury or poisoning (7%), or a disease of the circulatory system (6%).

Public hospital separations accounted for more than 77% of separations with a principal diagnosis in Diseases of the respiratory system (for example, asthma, pneumonia, chronic obstructive pulmonary disease) and almost 70% of pregnancy or childbirth separations (Figure 21).

Private hospitals accounted for more than 71% of separations with a principal diagnosis in Diseases of the eye and adnexa (for example, cataract extraction).

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 672,000 PPHs represented 7.3% of all hospital separations in 2011–12.

Overall, the number of PPHs per 1,000 population decreased by an average of 3.8% per year between 2007–08 and 2011–12. However, changes in how diabetes-related conditions were reported over this period were probably responsible for the majority of these decreases. Acute preventable conditions increased by an average of 7.5% per year between 2007–08 and 2011–12, and vaccine-preventable conditions were relatively stable. Chronic conditions (other than diabetes) decreased by 0.2%.

For chronic conditions, excluding diabetes, PPHs rose with increasing remoteness. In 2011–12, there were 9.0 PPHs per 1,000 population for chronic conditions in Major cities, and 21.7 per 1,000 in Very remote areas (Figure 22).

For acute conditions, the pattern was the same, ranging from 13.9 per 1,000 in Major cities to 31.1 per 1,000 in Very remote areas.

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, 16.8 and 12.7 per 1,000, and 17.5 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 (maintenance care)
• type of surgical or other procedure undertaken.

Broad category of service

In public hospitals, most separations were for medical care—77% in 2011–12, and 4% were for childbirth (Figure 23). About 21% of overnight separations were for surgical care, as were 14% of same-day separations.

Private hospitals provided a higher proportion of separations for surgical care than public hospitals—37% in 2011–12. Specialist mental health care was provided for 4% of private hospital separations.

For more information see below: States and territories: separations by broad category of service

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 2011–12 for 95% of separations and 80% of patient days for public hospitals and for 93% of separations and 85% of patient days for private hospitals.

Rehabilitation, or improved functioning, was the next most commonly reported intent of care. For 2011–12, it was reported for 1.7% of separations and 8.6% of patient days for public hospitals, and for 6.1% of separations and 12.0% of patient days for private hospitals.

For more information, see Admitted patient care: subacute and non-acute care

Procedures

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

In 2011–12, one or more procedures were reported for 82% of separations in Australian hospitals. Almost 95% of separations from private hospitals recorded a procedure, compared with 74% from public hospitals. Overall, 54% of separations that reported a procedure occurred in the public sector.

In 2011–12, many separations had a procedure reported that was for the urinary system (16%), the digestive system (13%), the musculoskeletal system (7%) or was gynaecological (4%). Also commonly reported were separations with non-invasive, cognitive and other interventions, including allied health and general anaesthesia (61%).

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: adverse events treated in hospital

For more information see Hospital performance: Staphylococcus aureus bacteraemia in 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 1 day’s stay, even if it is only for a few hours) and overnight care (care that is for at least 1 night), the average length of stay was 3.0 days in 2011–12, 2.3 days in private hospitals and 3.4 days in public acute hospitals. These averages have decreased over time (Figure 26), largely reflecting the fact that the proportion of separations that are day-only have increased.

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 2.9 days in public hospitals and 2.1 days in private hospitals (Figure 27). For Rehabilitation care, the average length of stay was 17.0 days in public hospitals and 4.6 days in private hospitals.

For more information see Hospital performance: relative stay index

For more information see Hospital performance: average length of stay

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?

More than half of all separations in 2011–12 were public patients (52%), who were not charged for their stay. Private health insurance accounted for a further 39%, and self-funded patients accounted for about 4% (Figure 31).

Between 2007–08 and 2011–12, there was an overall increase in separations of 4.1% per year. Separations funded by motor vehicle third-party personal claims increased by 7.6% per year and those funded by private health insurance increased by 5.5% per year (Figure 32). Separations funded by the Department of Veterans’ Affairs decreased by an average of 1.4% per year.

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States and territories: separations by broad category of service