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Various types of care are provided to admitted patients. The care type describes the overall nature of a clinical service provided to an admitted patient during an episode of care. Care type can be classified as:
In the data visualisation below you can explore the number of hospitalisations by care type for public and private hospitals between
2013–14 and 2016–17, and by hospital, between 2011–12 to 2016–17.
In 2017–18, for the public and private sectors combined:
The proportions of hospitalisations for each care type varied by hospital sector. Public hospitals accounted for 62% of hospitalisations for Acute care, while private hospitals accounted for 80% of hospitalisations for Rehabilitation care.
Between 2013–14 and 2017–18 the number of hospitalisations for Acute care increased by 3.8% on average per year for public hospitals, and by 1.4% per year for private hospitals
This section presents information on Newborn care provided for 2017–18. Newborns receiving care may have both ‘qualified’ and ‘unqualified’ days.
Between 2013–14 and 2017–18:
Between 2013–14 and 2017–18 Rehabilitation care rose by an average of 9.8% per year in private hospitals and fell by 1.3% per year in public hospitals.
Palliative care is defined as care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness.
Mental health care is defined as care in which the primary clinical purpose or treatment goal is improvement in the symptoms and/or psychosocial, environmental and physical functioning related to a patient’s mental disorder.
For 2017–18, mental health care refers to hospitalisationsfor which the care type was reported as Mental health. The care type Mental health was introduced from 1 July 2015. Prior to this, mental health admitted patient activity was assigned to one of the other care types.
What other information is available?
More information on type of care, appendixes and caveat information is available in Chapter 4: Why did people receive care? in the Admitted patient care 2017–18 report and Data tables.
Definitions of the terms used in this section are availabe in the Glossary.
An episode of Acute care for an admitted patient is one in which the principal clinical intent is to do one or more of the following:
Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an impairment, activity limitation, or participation restriction due to a health condition.
Rehabilitation care is always:
Palliative care is defined as care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. The patient will have complex physical, psychosocial and/or spiritual needs.
Palliative care is always:
Mental health care:
A day is considered ‘qualified’ for health insurance benefits purposes when a newborn meets at least 1 of the following criteria:
A newborn admission to hospital can occur at any time within the first 9 days of life, including at the time of birth.
The reporting of unqualified newborns has changed over time and varies across jurisdictions. Prior to 2017–18, newborn episodes involving unqualified care were routinely excluded from national reporting on the basis that they didn’t meet admission criteria for all purposes. However, due to changes in Newborn care practices (such as care being provided to unqualified newborns on the ward rather than in a special care nursery) stakeholders have expressed interest in the reporting of all newborn episodes, regardless of qualification status. Newborn care is reported in this section in total, or for both qualified and unqualified newborns, as indicated.
Last updated 20/02/2020 v24.0
Staphylococcus aureus (also S. aureus, or ‘Golden staph’) is a type of bacteria that can cause Staphylococcus aureus bacteraemia (SAB), an infection of the bloodstream.
SAB can be acquired after a patient receives medical care or treatment in a hospital. Contracting a Staph. aureus bloodstream infection while in hospital can be life threatening and hospitals aim to have as few cases as possible.
This measure is sourced from the National Staphylococcus aureus Bacteraemia Data Collection (NSABDC). Data for public hospitals are provided by state and territory health authorities, while data for participating private hospitals are provided on a voluntary basis by individual private hospitals and private sector hospital groups.
The current nationally agreed benchmark set under the National Healthcare Agreement (NHA) is no more than 2.0 cases of healthcare-associated Staph. aureus bloodstream infections per 10,000 days of patient care for public hospitals in each state and territory.
In the data visualisation below you can explore information on healthcare associated infections by hospital between 2010–11 and 2018–19.
Changes over time
Between 2014–15 and 2018–19:
Private hospitals participate in the NSABDC on a voluntary basis. The casemix of patients treated in private hospitals may also be different to that in public hospitals, therefore direct comparisons are unreliable. Not all private hospitals report data and reported data may not be representative of the sector as a whole.
NSABDC Data Quality Statement
National Healthcare Agreement: PI 22-Healthcare associated infections: Staphylococcus aureus bacteraemia
Appendixes and caveat information is available on the About the data page.
Definitions of the terms used in this section are available in the Glossary.
Data for public hospitals are provided by state and territory health authorities. Data for private hospitals are voluntarily provided by individual private hospitals and private sector hospital groups. The nationally agreed benchmark set under the National Healthcare Agreement (NHA) is no more than 2.0 cases of healthcare-associated S. aureus per 10,000 days of patient care for public hospitals in each state and territory.
The SAB infection rate is calculated as the number of healthcare-associated cases of S. aureus divided by the total number of patient days under surveillance (x 10,000).
Rates based on less than 5,000 patient days under surveillance are denoted as NP.
If the surveillance rate (patient days under surveillance/total number of patient days) is less than 95%, the rate is reported as interpret with caution (using the symbol *), as the sample under surveillance may not be representative of the hospital.
A case (patient-episode) of SAB infection is defined as a positive blood culture for S. aureus. For surveillance purposes, only the first isolate per patient is counted, unless at least 14 days has passed without a positive blood culture, after which an additional episode is recorded.
A SAB infection is considered to be healthcare-associated if the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge, or if the first positive blood culture is collected 48 hours or less after admission and one or more of the following clinical criteria was met for the case of S. aureus:
The definition of healthcare-associated S. aureus was developed by the Australian Commission on Safety and Quality in Health Care (the Commission). The Commission changed the definition in 2016, with clarification of the neutropenia criterion above. This definition of a healthcare-associated case of S. aureus was used by all states and territories for the 2015–16, 2016–17, 2017–18 and 2018–19 reporting years.
Data for 2010–11 to 2014–15 are provided according to the previous neutropenia criterion available at: http://meteor.aihw.gov.au/content/index.phtml/item id/598734.
Patient days under surveillance is the total number of days of admitted patient care under surveillance by infection control surveillance systems within the hospital.
Antimicrobial resistance occurs when some of the bacteria that cause infections resist the effects of the medicines used to treat them. This may lead to ‘treatment failure’, or the inability to treat the cause of the infection (Department of Health, 2020). Methicillin is an antimicrobial used to treat SAB infections.
A SAB infection that is identified by a laboratory as being caused by a methicillin-resistant strain of S. aureus is referred to as MRSA. A SAB case that is identified by a laboratory as being caused by a S. aureus strain that is sensitive to commonly used antimicrobials (methicillin-sensitive) is referred to as MSSA.
SAB infection caused by MRSA may cause more harm to patients and is associated with poorer patient outcomes as there are fewer antimicrobials available to treat the infection.
More information on antimicrobial resistance is available from the Department of Health website.
Hand hygiene ‘moments’
Hand hygiene is a key intervention to prevent or reduce Hospital Acquired Infections (HAIs), including S. aureus bloodstream (SAB) infections. Hand hygiene in hospitals generally refers to the washing and/or use of alcohol-based rubs by healthcare workers to clean their hands. Hand hygiene rates are calculated using the number of observed correct hand hygiene ‘moments’, or opportunities, in a specified audit period. ‘Moments’ of hand hygiene indicate when there is a perceived or actual risk of pathogen transmission from one surface to another via a person’s hands, and are defined in the World Health Organization (WHO) Guidelines on Hand Hygiene.
The National Hand Hygiene Initiative (NHHI) aims to educate and promote standardised hand hygiene practice in all Australian hospitals, and includes auditing and reporting processes for hospitals to measure how they are performing. The NHHI measures correct hand hygiene in the 5 critical moments determined by the WHO (modified slightly to reflect Australian health care conditions):
As of 1 November 2019, the NHHI coordination and support role is provided by the Australian Commission for Safety and Quality in Health Care (ACSQHC). The AIHW is currently working with the ACSQHC to review and establish new processes for publication of hand hygiene data from both public and private hospitals.
Hand hygiene data on MyHospitals currently reflects NHHI historical information to 2015. These will be updated when the current review process is complete and new arrangements are in place for reporting.
Hand hygiene data are provided by state and territory health authorities for public hospitals and by individual private hospitals. The data are derived from audits of hand hygiene opportunities, ‘moments’, that are conducted up to three times per year under the National Hand Hygiene Initiative.
Hospitals that provide information on hand hygiene report:
The estimated rate is compared to the national benchmark and is reported as:
Calculation of hand hygiene rates
The estimated hand hygiene rate for a hospital is a measure of how often (as a percentage) hand hygiene is correctly performed. It is calculated by dividing the number of observed hand hygiene ‘moments’ where proper hand hygiene was practised in a specified Audit Period, by the total number of observed hand hygiene ‘moments’ in the same Audit Period, and multiplying by 100. The rate is rounded to one decimal place.
Hand hygiene rate estimates and confidence intervals
Since the hand hygiene rates are based on audits from a sample of hand hygiene ‘moments’, in a sample of hospital wards the calculation is only an estimate of the true rate for that hospital, and is associated with a 95% confidence interval.
A ‘confidence interval’ is a statistical term describing the range (‘interval’) within which we can be sure (‘confident’) the true rate falls. Confidence intervals indicate the reliability of the estimated rate and are calculated using data provided by hospitals.
When only a small number of ‘moments’ are audited, the confidence interval is larger, meaning we are less sure of the true rate. When a large number of ‘moments’ are audited, the confidence interval is smaller, meaning we are more sure of the true rate.
Interim national benchmark
An interim benchmark (compliance rate) of 70% for hand hygiene reporting was initially advised by the Australian Commission on Safety and Quality in Health Care. This benchmark was increased to 75% in 2016, and increased again to 80% in 2017.
Length of stay is the number of days between admission to hospital, and separation. The Average Length of Stay (ALOS) is calculated as the total number of patient days reported for the hospital (or group of hospitals), divided by the number of hospitalisations.
The Organisation for Economic Co-operation and Development (OECD) presents comparative information on the ALOS for overnight hospitalisations as an indicator of efficiency. The comparability of international ALOS may be affected by differences in definitions of hospitals, collection periods and admission practices.
The ALOS for selected AR-DRGs is an indicator of Efficiency and sustainability under the Australian Health Performance Framework (AHPF).
In the data visualisation below, you can view the ALOS by selected medical procedures, by state and territory, and by type of hospital (peer group).
Significant changes in ALOS over time may be related to changes in admission practices and improvements in the coverage of reporting.
More information on type of care, appendixes and caveat information is available in Chapter 2: How much activity was there? in the Admitted patient care 2017–18 report and Data tables.
Average length of stay
The average length of stay (ALOS) is calculated as the total number of patient days reported for the hospital (or group of hospitals), divided by the number of separations. Two measures for ALOS are presented:
Performance indicator: Average length of stay for selected AR-DRGs
The ALOS for selected AR-DRGs is an indicator of Efficiency and sustainability under the Australian Health Performance Framework (AHPF). The selected AR-DRGs were chosen on the basis of:
Due to changes in the AR-DRG classification, the data presented here are not comparable with the data presented in previous years.
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