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Admission to hospital is a formal process. It follows a medical officer's 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.
Admitted patient services are either provided on a same-day basis or involve a stay in hospital overnight or longer.
Separations and patient days (the number of days of care provided) are useful measures of admitted patient services.
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The main measure of admitted patient care provided in Australian hospitals is the number of separations, or episodes of admitted patient care. Because separations can vary in length, another useful measure is patient days.
Between 2009–10 and 2013–14:
In 2013–14, there were about 9.7 million separations from Australian hospitals (Table 4):
.. not applicable, n.p. not published.
The number of overnight separations per 1,000 population in Australia for 2013–14 was in the midd of the range reported for other Organisation for Economic Co-operation and Development (OECD) countries in recent years (Figure 16) (OECD 2014).
Differences in definitions of hospitals, collection periods and admission practices are likely to affect the comparability of international separation rates.
For more international comparisons, see Chapter 2 of Admitted patient care 2013–14: Australian hospital statistics.
Note: Data for OECD countries vary in collection periods, by financial year and calendar year. Data are for 2011 and 2012 except for Korea (2013) and Australia (2013–14).
In 2013–14, almost 27.9 million days of admitted patient care were spent in hospital and over two-thirds of these were in public hospitals (Table 5).
For more international comparisons, see chapters 2 and 6 of Admitted patient care 2013–14: Australian hospital statistics.
Between 2009–10 and 2013–14, average lengths of stay for public acute and private hospitals fell slightly
In 2013–14, the average length of stay was generally higher for subacute and non-acute care than for acute care. The average length of stay was:
For patients who spent at least 1 night in hospital, the average length of stay was 5.7 days for public hospitals and 5.1 days for private hospitals.
For more information on length of stay, see chapters 2 and 4 of Admitted patient care 2013–14: Australian hospital statistics.
Relative stay indexes summarise the length of stay for admitted patients, with adjustments for 'casemix' (the types of patients treated and the types of treatments provided) They are regarded as indicators of the efficiency of hospitals.
A relative stay index greater than 1.0 indicates that an average patient's length of stay is higher than expected, given the casemix for the separations being considered A relative stay index of less than 1.0 indicates that the length of stay was less than expected.
Overall in 2013–14, the relative length of stay was lower in public hospitals than in private hospitals.
There were relatively shorter lengths of stay for Medical separations in public hospitals (0.94, compared with 1.28 in private hospitals), and for Surgical separations in private hospitals (0.99, compared with 1.03 in public hospitals) (Figure 18).
For more information on relative stay indexes, see Chapter 2 of Admitted patient care 2013–14: Australian hospital statistics.
The average length of stay for selected types of separations is regarded as an indicator of the efficiency of hospitals.
There were notable differences (more than 1 day) in the average length of stay between public and private hospitals for seven of these types of separations .The average length of stay for chronic obstructive airways disease without catastrophic complications or comorbidities was 4.1 days for public hospitals and 7.4 days for private hospitals (Figure 19).
For more information on length of stay, see Chapter 2 of Admitted patient care 2013–14: Australian hospital statistics.
CC—complications and/or comorbidities; CCC—catastrophic complications and/or comorbidities; CSCC—catastrophic or severe complications and/or comorbidities.
In 2013–14, there were 5.1 million separations for females and 4.6 separations for males. Overall:
In 2013–14, Aboriginal and Torres Strait Islander people were hospitalised at over twice the rate of other Australians (after accounting for age).
Aboriginal and Torres Strait Islander people were hospitalised:
Remoteness area categories divide Australia into areas depending on distances from population centres. Access to services can be measured by the number of separations per 1,000 population.
Data describing where patients live can be used to derive an approximation of their socioeconomic status 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 socioeconomic status groups, we would expect an equal number of separations for each group.
Overall, separations varied across the socioeconomic status groups and between public and private hospitals.
The reason that a patient receives admitted patient care can be described in a number of ways. These include the mode and urgency of admission, the type of care required and the principal diagnosis.
Mode of admission can be categorised as:
Admissions to hospital can be categorised as Emergency (required within 24 hours), or Elective (required at some stage beyond 24 hours). Urgency is not assigned for some admissions (for example, obstetric care and planned care, such as dialysis).
For more information see Chapter 4 of Admitted patient care 2013–14: Australian hospital statistics.
The care type can be classified as:
Most hospital separations are for acute care, that is, care with the intent to cure the condition, alleviate symptoms or manage childbirth.
The reason that a patient receives admitted patient care can be described in terms of a principal diagnosis or as a treatment for an ongoing condition (for example, dialysis for kidney failure).
For more information about common principal diagnoses, see the Infographic: Australia's hospitals 2013–14: at a glance (1.8MB PDF) .
For more information on principal diagnoses for same day and overnight acute separations see Chapter 4 of Admitted patient care 2013–14: Australian hospital statistics.
In 2013–14 about 6% of separations (624,000) were for injury or poisoning. The majority (81%) were treated in public hospitals. About 45% of these separations were for injuries to arms and legs.
Indigenous Australians were hospitalised for injury or poisoning at about twice the rate for other Australians.
Potentially preventable hospitalisations are separations that 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.
For more information on potentially preventable hospitalisations, see Chapter 4 of Admitted patient care 2013–14: Australian hospital statistics.
This indicator reports the number of hospital patient days taken up by Australians waiting for a residential aged care place .
The broad categories of admitted patient service include Childbirth, Specialist mental health, Medical (not involving a procedure), Surgical (involving an operating room procedure), or a non-surgical procedure, such as endoscopy (Other).
An intensive care unit can provide complex, multisystem life support. These units are located in tertiary referral centres and provide continuous mechanical ventilation, extracorporeal renal support and invasive cardiac monitoring for children or adults.
Rehabilitation care, aimed at improved functioning, accounted for 1.7% of separations and 8.6% of patient days for public hospitals, and 6.3% of separations and 12.4% of patient days for private hospitals.
Between 2009-10 and 2013-14 Rehabilitation care increased by an average of 11% per year in private hospitals and by 5% per year in public hospitals.
Palliative care is care in which the primary clinical purpose or treatment goal is to optimise the quality of life of a patient with an active and advanced life-limiting illness.
Overall, about 92% of admitted patients are discharged home (to their place of usual residence) at the end of their episode of care. Almost 6% are transferred to some other health care accommodation, including another hospital. Less than 1% died.
In 2013–14, 95% of separations from private hospitals had a mode of separation of Discharged home compared with 89% in public hospitals (Figure 29). However, a larger proportion of separations from public hospitals were discharged to some other health care accommodation, including another acute or psychiatric hospital, residential aged care or other health care accommodation.
For more information about how the care was completed, see Chapter 5 of Admitted patient care 2013–14: Australian hospital statistics.
Procedures reported for admitted patients can include surgical procedures, non operating-room procedures, procedures of a patient support nature and other interventions.
The rates for these hospital procedures are presented as an indicator of appropriateness and may also be indicators of accessibility of care .
Figure 30 presents separations per 1,000 population for selected hospital procedures The national rate is accompanied by the range of rates for these procedures by state or territory. There was some variation among states and territories for the selected procedures. For example, the national rate for cataract extraction was 8.9 per 1,000 population, but the state/territory rate ranged from 7.4 per 1,000 to 10.6 per 1,000 population.
For more information on surgical procedures, see Chapter 6 of Admitted patient care 2013–14: Australian hospitals statistics.
For more information about admitted patient funding sources, see Chapter 7 of Admitted patient care 2013–14: Australian hospital statistics.
Some information is available on the safety and quality of admitted patient care in hospitals, but this 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.
Adverse events are defined as incidents in which harm resulted to a person receiving health care .They include infections, falls resulting in injuries, and problems with medication and medical devices. Some of these adverse events may be preventable .
The number of separations that reported an adverse event per 100 separations was generally higher for:
For more information on separations with adverse events, see Chapter 8 of Admitted patient care 2013–14: Australian hospital statistics.
In 2013–14, more than 30,000 separations reported a fall resulting in harm that occurred in a health care service area. More falls per 1,000 separations were reported for public hospitals (4.2) than for private hospitals (1.6).
Unplanned or unexpected readmissions within 28 days of surgery are identified as those with a principal diagnosis related to an adverse event.
For more information on unplanned or unexpected readmissions, see Chapter 8 of Admitted patient care 2013–14: Australian hospital statistics.
Staphylococcus aureus bacteraemia (SAB), also known as golden staph bloodstream infection, is an important measure of the safety of hospital care . The aim is to have as few cases of SAB as possible . One of the most effective ways to minimise the risk of SAB and other healthcare-associated infections is good hand hygiene.
For more information, see Staphylococcus aureus bacteraemia in Australian public hospitals 2013–14: Australian hospital statistics (AIHW 2014d).