The main measure of activity is the number of hospitalisations (separations or episodes of admitted patient care). Because a hospitalisation can vary in length from ‘same-day’ to months, another useful measure of total activity is patient days. Patient days is the total number of days of care provided to patients.
This section presents information on:
This section also provides more detailed information on hospital care related to:
Impacts of COVID-19 on admitted patient activity
Between 2018–19 and 2019–20:
Between February and the end of June 2020, a range of restrictions were introduced to prevent and reduce the spread of coronavirus (COVID-19). Although initiatives varied between federal and state/territory governments, overall these measures aimed to reduce the spread of the virus and maintain adequate capacity of the healthcare system to deal with the pandemic.
During this period, a number of initiatives impacted on the provision of healthcare services and reduced the flow of patients seeking in-hospital care, including:
In addition, following a decision by National Cabinet, restrictions were applied to selected elective surgeries from 26 March 2020 to ensure that the hospital system maintained adequate capacity to deal with the COVID-19 pandemic.
Under these restrictions, only Category 1 and exceptional Category 2 procedures could be undertaken. These restrictions were gradually eased from 29 April 2020 onwards.
This range of measures impacted on the number of people being seeking hospital care, including to emergency departments and being admitted for elective surgery.
This section presents analysis of average weekly hospitalisations (presented by date of admission) over 2 years (2018–19 to 2019–20) to highlight the impact of COVID-19 on hospitalisations and allow comparison between years.
The data visualisations below present data on hospitalisations (by week of admission) for 2019–20, including:
Impact of COVID-19 on admitted patient activity
All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.
This line graph shows hospital admissions between 2018–19 and 2019–20. Data is presented by average daily admissions (by week), cumulative admissions (by week), projected vs actual daily admissions (by month) and urgency category. National, state and territory data is available.
Nationally, over the five years between 2014–15 and 2018–19, the number of hospitalisations increased on average by 3.3% each year.
However, between 2018–19 and 2019–20, the number of hospitalisations overall decreased by 2.8%:
This decrease was due to changes in behaviours and healthcare provision during the COVID-19 pandemic, including restrictions on non-urgent elective surgery. These effects varied between public and private hospitals.
For public hospitals, between 2018–19 and 2019–20:
Elective admissions involving surgery declined across most types of surgical procedures—including Procedures on ear and mastoid process (decrease of 26%), Procedures on ear and mastoid process (decrease of 14%), and Dental services (decrease of 12%).
For private hospitals, between 2018–19 and 2019–20:
From March to June 2020:
The 2019–20 data only includes hospitalisations with a separation date within the collection period, therefore, hospitalisations are underestimated towards the end of the collection period.
Projected estimates of hospitalisations for 2019–20 suggest that, without the impact of COVID-19, the average daily hospitalisations would have remained within the range of 29,900 to 34,900 between the months of March and June 2020.
See ‘More information about the Data’ section below for information on how the projected presentations data were calculated.
Projected hospital admissions were calculated using the average daily admissions for each month over a six-year period from 2013–14 to 2018–19.
The average change per year was then applied onto the 2018–19 data to create a projection for average daily admissions for each month in 2019–20.
Hospital admission data is captured for completed separations within the data year. Stays where the separation date did not occur within the same data year as the admissions are not included in the analysis. This is the likely cause of the apparent decrease in admission at the end of each data year.
Data tables on hospitalisations involving a COVID-19 diagnosis are available for download, Admitted patient care 2019–20: Separations with a COVID-19 diagnosis.
To explore the influence of the COVID‑19 on other health data, further releases are available on the AIHW website under COVID‑19 Resources.
Information on the total confirmed cases and active cases can be found on the Australian Government Department of Health website.
Data are also available on admitted patient care by hospital or LHN in My local area.
Appendixes and caveat information for this data is available to download in the Info and downloads section.
Definitions of the terms used in this section are available in the Glossary.
In March 2020, the Commonwealth and all state and territory governments signed the National Partnership on COVID-19 Response which coordinated a national emergency response to the COVID-19 pandemic. Although initiatives were coordinated federally, policies and practices varied between state/territory governments in how they recorded and monitored hospitalisations involving a COVID-19 investigation and/or diagnosis.
As part of a range of measures to reduce the spread and impact of the COVID-19 virus, the Australian Government Department of Health advised the public that certain people were at greater risk of more serious illness from the COVID-19 virus, if they become infected. Older people and people with multiple comorbid chronic conditions, including cardiovascular disease, obesity, diabetes, and chronic lung, kidney or liver conditions, are at greater risk of experiencing more severe illness from COVID-19.
This section presents data on hospitalisations involving a COVID-19 diagnosis and the demographic information on patients, the types of comorbid chronic diseases that were treated as part of in-hospital care and severity of illness patients’ experienced. Severity of illness is measured by a patient’s length of stay, whether hours in intensive care were recorded and how long patients received care in Intensive care units (ICU) and/or Continuous ventilatory support (CVS).
The data visualisations below show hospitalisations involving a COVID-19 diagnosis that occurred between 1 July 2019 and 30 June 2020, including by:
More information about definitions or technical specifications are provided in the 'More information about the data' section below.
Hospitalisations with a COVID-19 diagnosis
This bar graph shows the number of COVID-19 separations involving ICU in 2019–20. Data is presented by measure (age group, co-morbidity, Indigenous status, remoteness and socioeconomic status), sex and severity. In 2019–20, the age group with the highest number of COVID-19 separations was 65-74 years at 502 separations.
Nationally, in 2019–20:
Separations involving a COVID-19 diagnosis
Under the advice of the Independent Hospital Pricing Authority (IHPA), a diagnosis of COVID-19 was coded using emergency use ICD-10-AM diagnoses.
The analysis presented here includes hospitalisations with a diagnosis of
A third diagnosis code identified where infection with COVID-19 was tested and ruled out. This was not considered a diagnosis of COVID-19 for the purpose of the analysis in this report.
More information can be found on the IHPA website.
Older age is known to impact on health outcomes of patients hospitalised with a COVID-19 diagnosis (Australian Government 2021; Burrell et al. 2021).
The number of hospitalisations for patients with a COVID-19 diagnosis was similar for males and females (1,300 separations). Around 68% of hospitalisations involved a COVID-19 diagnosis for males aged 45 and over, which was slightly more compared to females in the same age group (62%).
There were more hospitalisations involving a COVID-19 diagnosis for patients who lived in capital cities and in areas classified as being the least disadvantaged. Of the 2,600 hospitalisations involving a COVID-19 diagnosis:
Hospitalisations in which the person spent time in an ICU and/or receiving CVS are an indication that the patient required a higher level of acute care as a result of an infection with the COVID-19 virus. During these hospitalisations, patients had at least one hour of ICU or CVS recorded, or a combination of both.
In 2019–20, of the 2,600 hospitalisations involving a COVID-19 diagnosis:
Emerging studies on COVID-19 found that patients with an underlying chronic condition are at higher risk of contracting the virus, and experiencing complications or more severe illnesses from COVID-19 (Ng et al. 2021; Burrell et al. 2021). Selected chronic conditions are known to affect the health outcomes of patients with COVID-19, including: cardiovascular disease, diabetes (type 1 and 2), asthma, chronic obstructive pulmonary disease (COPD), chronic kidney disease, obesity and other conditions.
When patients receive care during their hospitalisation, they may receive treatment for one or more conditions. Patients hospitalised with a COVID-19 diagnosis may have received care for another chronic condition, which is recorded as a primary diagnosis or in an 'other diagnostic field'. For this analysis, these diagnoses are referred to as ‘comorbid chronic conditions’. A list of the selected comorbid chronic conditions included in the analysis are provided in the ‘More information about the data’ below.
In 2019–20, hospitalisations involving a COVID-19 diagnosis for patients with one or more comorbid chronic conditions recorded were more likely to receive a higher level of acute care in an ICU and/or receive CVS.
Of the hospitalisations involving one comorbid chronic condition recorded:
Of the hospitalisations involving two or more comorbid chronic conditions recorded:
In comparison, hospitalisations involving no comorbid chronic conditions were less likely to involve time spent in ICU and/or receive CVS. Of the hospitalisations involving no comorbid chronic conditions recorded:
The most common comorbid conditions associated with COVID-19 hospitalisations were cardiovascular disease (13%) and Type 2 diabetes (10%).
Of those hospitalisations involving a recorded comorbid diagnosis of cardiovascular disease:
Of those with a recorded comorbid diagnosis of Type 2 diabetes:
More information on these data are available in Admitted patient care 2019-20 hospitalisations with a COVID-19 diagnosis
Data are also available on emergency department presentations by hospital or LHN in My local area.
To accurately capture data about separations with a COVID-19 diagnosis, the states and territories utilised ICD-10-AM diagnosesto identify confirmed, suspected, and ruled-out COVID-19 under the advice of the Independent Hospital Pricing Authority (IHPA).
Separations that began on any day, from 1 July 2019 to 30 June 2020, were included in the analysis. Therefore, the data does not capture hospitalisations involving a COVID-19 diagnosis that were separated after 30 June.
Selected comorbidity diagnoses were included in the analysis where a chronic condition occurred in any diagnostic field, including primary diagnosis. These chronic conditions impacted on the patient’s care during their hospital stay, while other existing chronic conditions (which did not impact on their care) are not included in the analysis.
The selected comorbidity chronic conditions were chosen based on the available Australian Government advice on health factors that may impact upon a person’s risk of contracting the COVID-19 virus (Australian Government 2021). Existing literature suggests that the comorbid chronic conditions may impact of the severity of a patient’s health outcomes when infected with COVID-19 (Ng et al. 2021; Burrell et al. 2021). The following chronic conditions could be included in the analysis based on the available data:
Australian Government 2021. Coronavirus (COVID-19) advice for people with chronic health conditions. Australian Department of Health. Viewed on 9 April 2021, https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-people-with-chronic-health-conditions
Ng, Wern Hann, et al. 2021. "Comorbidities in SARS-CoV-2 Patients: a Systematic Review and Meta-Analysis." Mbio 12.1.
Burrell, Aidan JC, et al. 2021. "Outcomes for patients with COVID‐19 admitted to Australian intensive care units during the first four months of the pandemic." Medical Journal of Australia 214.1: 23-30.
The main measure of admitted patient activity is the number of hospitalisations, or episodes of admitted patient care. Because episodes can vary in length from ‘same-day’ to many days or weeks, another useful measure of activity is patient days. Patient days are the total number of days of care provided to patients—a measure of activity that is independent of length of stay.
In the visualisations below, you can explore information on hospitalisations, patient days and patient day rates for admitted patients between 2015–16 and 2019–20.
Hospitalisations and patient days
These line graphs show the number of hospitalisations per 1,000 population, between 2015–16 and 2019–20. Data is presented by same day/overnight and hospital sector. National, state and territory data is available. In 2019–20, there were 246 same-day hospitalisations per 1,000 population and 155 overnight hospitalisations per 1,000 population.
This bar graph shows the number of hospitalisations between 2015–16 and 2019–20. Numbers and rates are presented by hospital sector and measure (average length of stay, overnight separations, patient days, same day separations and separations). National, state and territory data is available. In 2019–20, the average length of stay was 2.7 days compared with 2.8 days in 2015–16.
States and territories
This bar graph shows the number of hospitalisations per 1,000 population between 2015–16 and 2019–20. Data is presented by hospital sector. National, state and territory data is available. In 2019–20, the number of hospitalisations was 401 per 1,000 population compared with 413 hospitalisations in 2015–16.
From March to June 2020, the restrictions and measures introduced to manage and prevent the spread of the COVID-19 virus had a profound impact on healthcare services in Australia. It reduced the number of people admitted for selected elective surgeries and impacted on the number of people seeking hospital care.
Whereas, in previous years, the number of hospitalisations was generally increasing:
private hospitals accounted for 33% of patient days (30.2 million). Patient days that were in private hospitals ranged from 29% in South Australia to 38% in Queensland.
Coverage changes in public hospitals from 2018–19 to 2019–20 may influence changes over time.
More information about these data can be found in tables 2.1–2.7 in Admitted patient care: How much activity was there?
Definitions of the terms used in this section are available in the Glossary.
Patient days refers to the number of days of patient care provided to admitted patients.
The patient day rates presented in this report (patient days per 1,000 population) are age standardised to eliminate the effect of differences in population age structures over periods of time or across geographic areas (for example, for states and territories).
The numbers of public hospitals in Australia can vary over time, reflecting the opening or closing of hospitals, the reclassification of hospitals as non‑hospital facilities (or vice-versa) and the amalgamation of existing hospitals.
The number of hospitals reported can be affected by jurisdictional variations in administrative and/or reporting arrangements and is not necessarily a measure of the number of physical hospital buildings or campuses.
This section presents information on the number of public hospitals reporting activity to the National Hospitals Morbidity Database (NHMD) 2019–20.
Various types of public hospitals provide care to admitted patients including:
Peer group is a classification of public hospitals into groups by their size and the types of services provided.
In 2019–20, 669 public hospitals in Australia provided admitted patient care services—
Data on public hospitals providing admitted patient care in Australia comes from the Admitted patient care 2019–20: How much activity was there? data tables, Table 2.9.
Data from the National Public Hospital Establishments Database is available in the Info & downloads section.
More information, Appendixes and caveat information, and data tables are available in the Info & downloads section.
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 2015–16 and 2019–20, and by hospital, between 2011–12 to 2019–20.
Type of care
This column graph shows the number of hospitalisations by care type and private/public between 2015–16 and 2019–20. National data is presented by public/private and care type (acute, geriatric evaluation and management, maintenance care, mental health care, newborn care, palliative care, psychogeriatric care and rehabilitation care). In 2019–20, there were 6,320,160 Acute care separations in public hospitals and 3,830,990 Acute care separations in private hospitals.
Hospitals and LHNs
This table explores on the number of hospital admissions between 2011–12 and 2016–17. Data is presented by measure (number of admissions and care type). Hospital-level data is available.
In 2019–20, 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 79% of hospitalisations for Rehabilitation care.
Between 2018–19 and 2019–20, the number of hospitalisations for Acute care decreased by 1.7% for public hospitals and by 4.0% for private hospitals.
This section presents information on Newborn care provided for 2019–20. Newborns receiving care may have both ‘qualified’ and ‘unqualified’ days. Refer to ‘More information about the data’ section below for definitions on qualified and unqualified care.
Overall, 95% of hospitalisations for newborn care had a separation mode of Discharged home—these hospitalisations include newborn care without qualified days and those with at least one qualified days, or a combination of the two.
Between 2018–19 and 2019–20, Rehabilitation care fell by an average of 12.0% in private hospitals and fell by 6.7% 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.
Between 2018–19 and 2019–20:
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 2019–20, mental health care refers to hospitalisations for 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 these data are available in the Admitted patient care 2019–20: What services were provided? data tables.
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 is defined in this publication 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.
Mental health care:
Mental health care differs from mental health-related care reported in AIHW Mental health services reports. A separation is classified as mental health-related if:
A day is considered ‘qualified’ for health insurance benefits purposes when a newborn meet 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 did not 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.
The principal diagnosis is the diagnosis established after study (for example, at the completion of the episode of care) to be chiefly responsible for causing the episode of admitted patient care. In some cases, the principal diagnosis is described in terms of a treatment for an ongoing condition (for example, Care involving dialysis).
This section presents information on the numbers of hospitalisations by ICD-10-AM chapters, and the 20 most common detailed principal diagnoses (at the 3-character level) for public and private hospitals for 2019–20.
Same-day acute separations
More information on these data are available in tables 4.6–4.9 in the Admitted patient care 2019–20: Why did people receive care? data tables.
Interventions include surgical procedures, non-surgical investigative procedures, and therapeutic interventions. They require specialised training and/or require special facilities or services available only in an acute care setting. Types of interventions include:
Impact of COVID-19 on elective surgery activity in 2019–20
Between February and the end of June 2020, a range of measures were introduced to prevent and reduce the spread of coronavirus (COVID-19). As part of these measures, following a decision by National Cabinet, restrictions were applied to selected elective surgeries from 26 March 2020.
Under these restrictions, only Category 1 and exceptional Category 2 elective surgery procedures could be performed. These restrictions were eased (but not fully lifted) from 29 April 2020, allowing all Category 2 and some important Category 3 procedures to be performed.
These restrictions led to an overall decrease in hospital admissions generally, but particularly for elective surgery admissions. Between 2018–19 and 2019–20:
Between 2014–15 and 2018–19, elective admissions involving surgery increased by 1.5% and emergency admissions involving surgery increased by 3.3%, on average, each year.
More information about the impact of COVID-19 on public hospital elective surgery waiting lists are available in the Elective surgery activity area of the MyHospitals website.
This section presents information on all surgical separations (operating room procedures).
More information on these data are available in tables 6.1–6.12 in the Admitted patient care 2019–20: What procedures were performed? data tables.
Surgical separations are identified as separations with a ‘surgical AR-DRG’. Surgical separations for childbirth, and subacute and non-acute separations are included in these. Therefore, the data presented for 2015–16 to 2017–18 are not comparable with 2014–15 and earlier.
Emergency admissions involving surgery are identified as acute care separations with a ‘surgical AR-DRG’, and for which the urgency of admission was reported as Emergency—indicating that the patient required admission within 24 hours.
Elective admissions involving surgery are identified as separations with a ‘surgical AR DRG’ and for which the urgency of admission was reported as Elective—indicating that admission could be delayed beyond 24 hours. They do not include separations where the urgency of admission was Not assigned or was not reported
This section presents information on the number of hospitalisations with a principal diagnosis in the ICD-10-AM chapter Injury, poisoning and certain other consequences of external causes for public and private hospitals over 2019–209. The information is also presented by:
More information on these data are available in tables 4.6–4.13 in the Admitted patient care 2019–20: Why did people receive care? data tables.
An external cause is defined as the environmental event, circumstance or condition that was the cause of injury, poisoning or adverse event. Whenever a patient has a principal or additional diagnosis of an injury or poisoning, an external cause code should be recorded. External causes may also be required for other selected diagnoses. More than one external cause code may be reported for a separation, and the external causes presented may not relate to the principal diagnosis.
Some hospitalisations for injury or poisoning may be considered potentially avoidable. It should be noted that the admitted patient care data provide only a partial picture of the overall burden of injury because the data do not include injuries that do not require admission to hospital: for example, that were not medically treated, were treated by general practitioners or were treated in emergency departments (without being admitted).
Intensive care is provided to patients who are critically unwell and require complex, multisystem life support such as mechanical ventilation, extracorporeal renal support and invasive cardiovascular monitoring. This section presents information on care in intensive care units provided to patients in 2019–20.
Public hospitals that have either an approved level 3 adult Intensive Care Unit (ICU) or an approved paediatric and/or Neonatal ICU are required to report the number of hours spent in an ICU for each hospitalisation.
Hospitalisations with a COVID-19 diagnosis and time spent in ICU
Australia’s hospital system has played a significant role in managing and treating people with the coronavirus virus (COVID-19).
Between January and June 2020, there were over 2,600 hospitalisations involving a COVID-19 diagnosis, either U07.1 [COVID-19, virus identified] or U07.2 [COVID-19, virus not identified] which means the virus was clinically diagnosed.
In 2019–20, of these 2,600 hospitalisations involving a COVID-19 diagnosis:
More information about separations involving a COVID-19 diagnosis can be found in the section ‘Hospitalisations with a COVID-19 diagnosis’ above.
For public hospitals in 2019–20:
For private hospitals in 2019–20:
Continuous ventilatory support (CVS) refers to the use of invasive ventilatory support or mechanical ventilation (a machine to assist breathing).
CVS is usually, but not always, provided within an ICU. Some stays in ICUs do not involve ventilatory support.
More information about these data are available in data tables 5.6–5.8 and S5.8–S5.9 in Admitted patient care 2019–20: What services were provided?
A level 3 adult Intensive Care Unit (ICU) or a paediatric ICU must:
If a patient’s episode involves more than 1 period in an ICU, then the total number of hours in ICU are summed for reporting.
The quality of data submitted for separations involving ICU varies across jurisdictions.
Continuous ventilatory support (CVS—also known as invasive ventilatory support or mechanical ventilation) refers to the use of a machine to assist breathing.
Periods of ventilatory support that are associated with anaesthesia during surgery, and which are considered an integral part of the surgical procedure, are not reported here. The quality of data submitted for separations involving CVS varies across jurisdictions.
The nature of the services provided to an admitted patient during an episode of care can be described in a number of ways including:
Hospitalisations are categorised into the following broad categories of service:
See the 'More information about the data' section below for more information on broad category of service.
In 2019–20, for public hospitals:
In 2019–20, for private hospitals:
Between 2015–16 and 2019–20:
More information on how COVID-19 may have impacted on the year-to-year changes in hospitalisation rates can be found in the section 'Impact of COVID-19 on admitted patient activity’.
More information on these data are available in tables 5.1–5.5 in Admitted patient care: What services were provided?
The broad categories of service are:
Subacute and non-acute care: hospitalisations for which the care type was Rehabilitation care, Palliative care, Psychogeriatric care, Geriatric evaluation and management or Maintenance care
Information on the numbers of acute care hospitalisations for Major Diagnostic Categories (MDCs) and Australian Refined Diagnosis Related Groups (AR‑DRGs) is presented.
The AR-DRG is a classification system developed to provide a clinically meaningful way of relating the number and type of patients treated in a hospital to the resources required by the hospital. Hospitalisations are assigned to MDCs and AR-DRGs mostly based on the diagnoses and interventions reported.
The Organisation for Economic Co-operation and Development (OECD) presents comparative information on the average length of stay (ALOS) for overnight separations as an indicator of efficiency. The comparability of international ALOS may be affected by differences in definitions of hospitals, collection periods and admission practices.
This section includes information on the proportion of surgeries performed on a same-day basis for:
The number of:
The proportion of surgeries performed laparoscopically for:
A high proportion of cataract surgeries performed on a same-day basis may point to the efficient use of resources.
Laparoscopic (keyhole) surgery is less invasive (and therefore considered to be safer) than ‘open’ approaches.
In 2019–20, Australia had higher proportions of the 3 selected procedures that were performed laparoscopically:
More information is available in tables 6.5–6.6 in Admitted patient care: What procedures were performed?
International comparisons are available on the OECD.Stat website.
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