Admitted patient activity

This section presents analysis of average weekly hospitalisations (presented by date of admission) over 3 years (2018–19 to 2020–21) to highlight the impact of COVID-19 on hospitalisations and allow comparison between years.

Explore the data

The data visualisations below present data on hospitalisations (by week of admission) for between 2018–19 and 2020–21, including:

• average daily hospitalisations (by week of admission) by
  • state and territory
  • urgency category
• actual and projected hospitalisations for 2019–20 and 2020–21 (by month).

Highlights

Hospitalisations decreased between 2018–19 and 2019–20

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%:

• hospitalisations in public hospitals decreased by 1.7%
• hospitalisations in private hospitals decreased by 4.5%.

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, in 2019–20:

• same-day hospitalisations decreased by 0.2% compared with 2018–19 and overnight hospitalisations decreased by 3.4%
• hospitalisations with an urgency category of Emergency decreased by 2.8% and Elective admissions decreased by 2.6%.

For private hospitals, between 2018–19 and 2019–20:

• same-day hospitalisations decreased by 4.1% and overnight hospitalisations decreased by 5.5%
• hospitalisations with an urgency of admission of Emergency decreased by 3.3% and Elective admissions decreased by 6.2%.

Admitted patient activity returning to normal in 2020–21

In 2020–21, admitted patient activity increased when compared with 2019–20, approaching levels projected based on pre-COVID year-on-year average increases: 

• overall, hospitalisations increased by 6.3% from 11.1 to 11.8 million hospitalisations
• overnight hospitalisations increased by 3.3% and same-day hospitalisations increased by 8.1%
• the largest increase was for hospitalisations in private free-standing day hospitals (13.9%) compared with hospitalisations in public acute hospitals (3.6%)
• hospitalisations in Other private hospitals, (or private hospitals offering a mix of same-day and overnight hospitalisations) increased 9.5%.

Because of the way in which admitted patient care data is compiled, hospitalisations are underestimated at the end of each collection period. This is because the datasets only include hospitalisations with a separation date within the collection period, and therefore do not include data about patients for which the episode of care had begun, but had not yet ended.

See ‘More information about the Data’ section below for information on how the projected presentations data were calculated.

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 provides information about the demographic characteristics of patients, the types of comorbid chronic diseases that were treated as part of in-hospital care and the 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).

Explore the data

The data visualisations below show hospitalisations involving a COVID-19 diagnosis that occurred between 1 July 2020 and 30 June 2021, including by:

• sex and age
• Indigenous status
• remoteness of area of usual residence
• socioeconomic status of area of usual residence
• hospitalisations involving a stay in intensive care and/or hours of continuous ventilatory support
• comorbid chronic conditions.

More information about definitions or technical specifications are provided in the 'More information about the data' section below.

How many hospitalisations involved a COVID-19 diagnosis?

Nationally, in 2020–21:

• there were 4,700 hospitalisations involving a COVID-19 diagnosis, including 4,400 hospitalisations where the COVID-19 virus was identified (U07.1–COVID-19, virus identified) and 290 hospitalisations where the COVID-19 virus was clinically diagnosed (U07.2, COVID-19, virus not identified with laboratory testing)
• the average length of stay for hospitalisations for patients with a COVID-19 diagnosis was 9 days on average, which ranged from 1 day to 230 days (nearly 8 months).

Who received hospital care for a COVID-19 diagnosis?

Older age is known to impact on health outcomes of patients hospitalised with a COVID-19 diagnosis (Australian Government 2021; Burrell et al. 2021).
In 2020–21:

• 66% of hospitalisations were for people aged 45 or older
• only 4.3% of hospitalisations were for infants or young children, aged 0–14.

The number of hospitalisations for patients with a COVID-19 diagnosis was slighly higher for females (2,400 hospitalisations) than males (2,300 hospitalisations).

Where did patients with a COVID-19 diagnosis live?

There were more hospitalisations involving a COVID-19 diagnosis for patients who lived in cities and in areas classified as being the least disadvantaged.

In 2020–21, of the 4,700 hospitalisations involving a COVID-19 diagnosis:

• almost 9 in 10 hospitalisations (89%, or 4,200 hospitalisations) were for people living in Major cities
• 1 in 20 were for people living in Inner regional areas (5%, or 250 separations)
• less than 1% of hospitalisations were for patients who usually lived in in Remote and Very Remote areas
• just under 1 in 4 (24%) of hospitalisations involving COVID-19 diagnosis were for patients living in areas classified as the lowest socioeconomic status (SES) group
• just under 1 in 6 (16%) hospitalisations were for patients living in areas classified as the highest SES group

• over 9 in 10 (93%) hospitalisations involving a COVID-19 diagnosis were for non-Indigenous Australians and less than 1% were for people of Aboriginal and Torres Strait Islander origin.

Intensive care for hospitalisations involving 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 2020–21, of the 4,700 hospitalisations involving a COVID-19 diagnosis:

• 7.0% of hospitalisations involved a stay in ICU, during which patients received an average of 130 hours in ICU care
• 3.8% of hospitalisations involved CVS
• 10.3% of hospitalisations had a separation mode indicating that patient died in hospital.

Hospitalisations involving a COVID-19 diagnosis with a comorbid chronic condition

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 additional diagnosis. 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.

Comorbid chronic conditions

In 2020–21, of the 4,700 hospitalisations involving a COVID-19 diagnosis:

• most hospitalisations (58%) recorded no comorbid chronic condition recorded
• 26% of hospitalisations recorded one comorbid chronic comorbid condition recorded
• 15% of hospitalisations recorded two or more chronic comorbid conditions recorded.

In 2020–21, 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 with one comorbid chronic condition recorded:

• 10% of hospitalisations involved time spent in ICU
• 5% involved CVS
• 14% had separation mode indicating the patient died in hospital.

Of the hospitalisations with two or more comorbid chronic conditions recorded:

• 16% of hospitalisations involved time spent in ICU
• 11% involved CVS
• 26% had a separation mode indicating the patient died in hospital.

In comparison, hospitalisations involving no comorbid chronic conditions were less likely to involve time spent in ICU and/or receive CVS. Of the hospitalisations with no comorbid chronic conditions recorded:

• 3.1% hospitalisations involved time spent in ICU
• 1.4% involved CVS
• 5% had a separation mode indicating the patient died in hospital.

Patients who received treatment in ICU and/or CVS with a comorbid condition

The most common comorbid conditions associated with COVID-19 hospitalisations were cardiovascular disease (20%) and Type 2 diabetes (20%).

Of those hospitalisations with a recorded comorbid diagnosis of cardiovascular disease:

• 18% of hospitalisations involved time spent in ICU
• 13% involved CVS
• 20% had a separation mode indicating the patient died in hospital.

Of those with a recorded comorbid diagnosis of Type 2 diabetes:

• 12% of hospitalisations involved time spent in ICU
• 7% involved CVS
• 19% had a separation mode indicating the patient died in hospital.

How many patients were hospitalised with an adverse effect of a COVID-19 vaccination?

Covid vaccinations commenced in Australia on the 22nd of February 2021. During the 2020–21 collection period, the Australian Government Department of Health reported there were just over 7.6 million doses of vaccine administered across Australia.

Between 22nd February 2021 and 30 June 2021, there were 2,000 hospitalisations assigned the external cause code U07.7 [Emergency use of U07.7: COVID-19 vaccines causing adverse effects in therapeutic use]. 

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.

Explore the data

In the visualisations below, you can explore information on hospitalisations, patient days and patient day rates for admitted patients between 2016–17 and 2020–21.

Highlights

Hospitalisations

In 2019–20, 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.

Nationally, from 2014–15 to 2018–19, hospital admissions increased by 3.3%, on average, each year. However, due to the restrictions and measures put in place to manage and prevent the COVID-19 virus, hospitalisations in 2019–20 decreased by 2.8%. In 2020–21, admitted patient activity again increased, approaching levels expected had pre-COVID year-on-year average increases continued. 

In 2020–21: 

• overall, hospitalisations increased by 6.3% compared to 2019–20 – from 11.1 to 11.8 million hospitalisations
• the largest increase was for hospitalisations in private free-standing day hospitals (13.9%), while hospitalisations in public hospitals increased by 3.6%
• hospitalisations in Other private hospitals, (or private hospitals offering a mix of same-day and overnight hospitalisations) increased 9.5%
• overnight hospitalisations increased by 3.3% and same-day hospitalisations increased by 8.1%.

Patient days

In 2020–21:

• public hospitals accounted for 67% of patient days (20.9 million) and private hospitals accounted for 33% of patient days (30.2 million).

Compared with 2019–20, in 2020–21:

• overall, the number of patient days increased by 3.1% – from 30.2 million to 31.2 million patient days
• patient days increased by 5.4% in private hospitals and 2.1% in public hospitals
• patient days per 1,000 population increased from 1,067 in to 1,077.

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) 2020–21. The hospitals providing admitted patient care services is a smaller group of hospitals compared to the total number of public hospitals in Australia, published in the National public hospital establishments database (NPHED)

Public hospitals providing admitted patient care

Various types of public hospitals provide care to admitted patients including:

• Principal referral hospitals
• Public acute group A hospitals
• Very small hospitals
• Subacute and non-acute hospitals.

Peer group is a classification of public hospitals into groups by their size and the types of services provided.

In 2020–21, 672 public hospitals in Australia provided admitted patient care services:

• 31 Principal referral hospitals accounted for the highest proportion of public hospital separations (37%, or 2.6 million hospitalisations) and public hospital patient days (38%, or 7.8 million patient days)
• 63 Public acute group A hospitals accounted for a further 35% of hospitalisations and 32% of patient days
• 109 Very small hospitals accounted for less than 1% of both hospitalisations and patient days, with an average length of stay of 10.3 days which was much longer than the average length of stay in Principal referral hospitals
• 34 Subacute and non-acute hospitals accounted for 0.8% of hospitalisations and 3.5% of patient days, with an average length of stay of 12.4 days.

Hospitals provide various types of care 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:

• Acute care
• Newborn care
• Subacute and non-acute care—Rehabilitation care, Palliative care, Geriatric evaluation and management, Maintenance care and Psychogeriatric care
• Mental health care.

Explore the data

In the data visualisation below you can explore the number of hospitalisations by care type for public and private hospitals between 2016–17 and 2020–21, and by hospital, between 2012–13 to 2020–21.

Highlights

In 2020–21, for the public and private sectors combined:

• over 9 in 10 (94%) hospitalisations were classified as episodes of Acute care
• 3.6% were classified as episodes of as Rehabilitation care
• 3.2% were classified as episodes of as Mental health care
• 0.5% were classified as episodes of as Newborn care (with at least one qualified day).

The proportions of hospitalisations for each care type varied by hospital sector. Public hospitals accounted for 61% of hospitalisations for Acute care, while private hospitals accounted for 81% of hospitalisations for Rehabilitation care.

Acute care

In 2020–21:

• around 9 in 10 hospitalisations in public (94%) and private hospitals (87%) were for Acute care 
• the most common principal diagnosis (at the 3-chartacter level) reported for overnight acute hospitalisations was Single spontaneous delivery (3.1% of hospitalisations)
• almost 1 in 4 (23%) of same-day acute hospitalisations had a principal diagnosis of Care involving dialysis.

In 2020–21, the number of hospitalisations for Acute care increased by 3.8% for public hospitals and by 11.1% for private hospitals compared with 2019–20.

Newborn care

This section presents information on Newborn care provided for 2020–21. Newborns receiving care may have both ‘qualified’ and ‘unqualified’ days. Refer to ‘More information about the data’ section below for definitions of qualified and unqualified care.

In 2020–21:

• there were 81,500 hospitalisations for newborn care with at least one qualified day—the majority of these (86%) occurred in public hospitals
• 1 in 4 hospitalisations for newborn care had a principal diagnosis of Disorders related to short gestation and low birth weight, not elsewhere classified (25% of hospitalisations for qualified newborns) followed by Respiratory distress of newborn (14% of hospitalisations for qualified newborns).

Overall, almost all (95%) hospitalisations for newborn care were Discharged home—these hospitalisations include newborn care without qualified days and those with at least one qualified day, or a combination of the two.

In 2020–21:

• Newborn care ​hospitalisations for qualified newborns increased by 7.1% in public hospitals and 5.9% in private hospitals compared with 2019–20
• for unqualified newborns, Newborn care hospitalisations increased by 0.8% for public hospitals and 14.9% for private hospitals.

Subacute and non-acute care

In 2020–21:

• less than 1 in 20 hospitalisations (4.8%) were for Subacute and non-acute care. 
• the number of hospitalisations for Subacute and non-acute care decreased by 2.3% in public hospitals and increased by 5.3% in private hospitals compared with 2019–20.

Rehabilitation care

In 2020–21:

• there were over 430,000 Rehabilitation care hospitalisations, with 4 in 5 (81%) occurring in private hospitals
• Rehabilitation care accounted for over 9 in 10 (95%) of Subacute and non-acute care hospitalisations for private hospitals and over 4 in 10 (42%) for public hospitals
• females accounted for more than half (56%) of all Rehabilitation care hospitalisations 
• Indigenous Australians had lower hospitalisations rates for Rehabilitation care than Other Australians (8.5 per 1,000 and 13.6 per 1,000 population, respectively)
• people in Major cities had higher rates of Rehabilitation care in private hospitals compared to people who live in other remoteness areas (13.5 hospitalisations per 1,000 population compared with 11.0 per 1,000 nationally)
• Just over half (52%) of Rehabilitation care hospitalisations in public and private hospitals had a principal diagnosis in the ICD-10-AM chapter Diseases of the musculoskeletal system and connective tissue—which includes conditions such as arthrosis of the knee or hip, back pain and other joint disorders.

Between 2019–20 and 2020–21, Rehabilitation care increased by 5.7% in private hospitals and fell by 6.7% in public hospitals.

Palliative care

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.

In 2020–21:

• nearly 9 in 10 (86%) of the 49,000 hospitalisations with a care type of Palliative care occurred in public hospitals
• 1 in 2 hospitalisations for Palliative care had a neoplasm-related (cancer-related) principal diagnosis, with Malignant neoplasm of bronchus and lung accounting for 8% of Palliative care hospitalisations
• the most common non-neoplasm-related principal diagnoses for Palliative care included Other sepsis, Heart failure and Pneumonitis due to solids and liquids.

In 2020–21 Palliative care hospitalisations decreased by 4.7% in private hospitals and increased by 2.7% for public hospitals compared with 2019–20.

Mental health care

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 2020–21, 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.

In 2020–21:

• over 3 in 5 (62%) of the 375,000 Mental health care hospitalisations occurred in private hospitals
• almost 9 in 10 (88%) hospitalisations in public hospitals involved a stay of at least one night
• 4 in 5 (79%) hospitalisations for Mental health care in private hospitals were for same-day care
• females accounted for 3 in 5 (59%) of all Mental health care hospitalisations.

The principal diagnosis is the diagnosis—established  after the completion of the hospitalisation—to be chiefly responsible for 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). Diagnoses are recorded using the relevant version of the International statistical classification of diseases and related health problems, Australian modification (ICD-10-AM).

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 2020–21.

Highlights

Most common diagnosis chapters (ICD-10-AM)

In 2020–21:

• nearly 1 in 4 (24%, 2.9 million) hospitalisations had a principal diagnosis in the ICD-10-AM chapter Factors influencing health status and contact with health services—which includes Care involving dialysis (around 1.6 million separations), radiotherapy and chemotherapy
• the relative distribution of hospitalisations by ICD-10-AM chapter varied across public and private hospitals. For example, 86% of hospitalisations for Certain conditions originating in the perinatal period  and 82% of hospitalisations for Certain infectious and parasitic diseases and were provided in public hospitals. For Diseases of the eye and adnexa, about 73% of hospitalisations were in private hospitals
• almost 1 in 2 (47%) hospitalisations for Indigenous Australians had a principal diagnosis in the ICD-10-AM chapter Factors influencing health status and contact with health services, compared with less than 1 in 4 (23%) Other Australians
• hospitalisation rates for Indigenous Australians were 6 times the rate for Other Australians for Factors influencing health status and contact with health services (which includes Care involving dialysis), and more than twice the rate for Diseases of the skin and subcutaneous tissue, Diseases of the respiratory system and Endocrine, nutritional and metabolic diseases (which includes Diabetes mellitus).

Most common principal diagnoses (at the 3 character level)

Same-day acute hospitalisations

In 2020–21:

• nearly 1 in 4 (23%, 1.6 million) of same-day acute hospitalisations were for Care involving dialysis and these hospitalisations accounted for 1 in 3 (33%) of all same-day acute hospitalisations in public hospitals
• the next most common same day acute hospitalisations were those associated with principal diagnoses of Other medical care and Other cataract which accounted for 9.3% and 3.8% of all same day hospitalisations respectively
• same-day acute hospitalisations for Pain in throat and chest and Care involving dialysis were the most likely to be provided by public hospitals (92% and 79% were provided in public hospitals, respectively)
• same-day acute hospitalisations for Procreative management (95%), Embedded and impacted teeth (94%), Other retinal disorders (89%), and Benign neoplasm of colon, rectum, anus and anal canal (79%) were the most likely to be provided in private hospitals.

Overnight acute hospitalisations

In 2020–21:

• over 2 in 3 overnight acute hospitalisations were provided in public hospitals (2.8 million or 70%)
• the most common principal diagnosis (at the 3-character level) reported for overnight acute hospitalisations was Single spontaneous delivery, which accounted for 3.6% of overnight acute separations in public hospitals and 1.8% in private hospitals
• private hospitals provided a majority of overnight acute hospitalisations for Gonarthrosis (arthrosis of the knee, 71%), Coxarthrosis (arthrosis of hip, 70%), Sleep disorders (66%), and Chronic ischaemic heart disease (63%).

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:

• Surgical procedures—operating room procedures
• Non-surgical investigative and therapeutic procedures—such as X-rays, diagnostic testing and dialysis
• Patient support interventions that are neither investigative nor therapeutic—such as general anaesthesia, physiotherapy and other allied health interventions
• Physiological assessments undertaken by doctors, nurses, and allied health professionals
• Manufacture and fitting of devices, aids or equipment
• Psychological therapies and skills training.

How many interventions were provided by hospitals in Australia?

• 25.8 million interventions were reported, with 13.4 million performed in public hospitals, and 12.5 million in private hospitals
• almost 4 in 5 (78%) hospitalisations in public hospital and nearly all (96%) hospitalisations in private hospital involved at least one intervention
• public hospitals accounted for 4 out of 5 (80%) Obstetric procedures (including childbirth) and Procedures on respiratory system (78%)
• 3 in 4 (76%) Radiation oncology procedures were performed in public hospitals
• private hospitals accounted for almost 4 out of 5 Dental services procedures (79%) provided and Procedures on nervous system (78%).

How many interventions were provided to patients receiving same-day acute care?

In 2020–21:

• 11.8 million interventions were reported for patients in same-day acute care hospitalisations
• 4 out of 5 (79%) of these hospitalisations in public hospitals and 99% of hospitalisations in private hospitals involved an intervention
• Cerebral anaesthesia (general anaesthesia and sedation, 2.7 million procedures), Haemodialysis (1.6 million) and Administration of pharmacotherapy (mostly chemotherapy, 1.0 million) accounted for almost half (45%) of all procedures.

How many interventions were provided to patients receiving overnight acute care?

In 2020–21:

• 11.5 million interventions were reported for patients receiving overnight acute care hospitalisations
• 3 in 4 (75%) of these hospitalisations in public hospitals and 9 in 10 (90%) hospitalisations in private hospitals involved at least one intervention
• 2 in 5 (41%) interventions in public hospitals (3.1 million) were Generalised allied health interventions (for example, physiotherapy and other rehabilitation procedures).

How many surgical procedures were provided?

This section presents information on hospitalisations involving a surgical procedure undertaken in an operating theatre. In 2020–21:

• 1 in 4 hospitalisations (25%) involved surgery and 3 out of 5 (59%) of these occurred in private hospitals. These accounted for 17% of hospitalisations in public hospitals and 36% of hospitalisations in private hospitals
• there were 2.4 million elective admissions involving surgery and 68% of these occurred in private hospitals
• for public hospitals, over 3 in 5 (65%) surgical hospitalisations were elective admissions, 27% were emergency admissions and 8% did not have an urgency status assigned
• for private hospitals, more than 9 in 10 (94%) surgical hospitalisations were elective admissions, 3% were emergency admissions, and 3% did not have an urgency status assigned.

Emergency hospitalisations involving surgery

In 2020–21:

• there were 388,000 emergency hospitalisations involving surgery (where hospitalisation was required within 24 hours)
• almost 9 in 10 (86%) of these occurred in public hospitals
• the most common principal diagnosis associated with these hospitalisations was Acute appendicitis and Fracture of femur
• Other debridement of skin and subcutaneous tissue was the most common surgical intervention (at the procedure block level) for emergency admissions involving surgery, and most (91%) of these were performed in public hospitals.

Elective hospitalisations involving surgery

In 2020–21:

• there were 2.4 million elective hospitalisations involving surgery (where hospitalisation could be delayed more than 24 hours)
• almost 7 in 10 (68%) of these occurred in private hospitals
• Other cataract surgery was the most common surgical intervention (at the procedure block level) for elective hospitalisations involving surgery with almost 3 in 4 (73%) of these performed in private hospitals.

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 2020–21. The information is also presented by:

• Indigenous status
• the external cause of injury and poisoning.

Highlights

In 2020–21:

• about 1 in 14 (7.1%, 841,000) hospitalisations had a principal diagnosis of Injury, poisoning and certain other consequences of external causes—the majority (78%) were treated in public hospitals
• almost half (46%) of all injury hospitalisations had a principal diagnosis of Injuries to upper and lower limbs, and 17% (144,100 hospitalisations) had a principal diagnosis of Complications of medical and surgical care 
• 2 in 5 hospitalisations for injury were for Falls (38%, 316,000 hospitalisations). 

Indigenous Australians

In 2020–21:

• There were 43,100 hospitalisations with a principal diagnosis of injury, poisoning and certain other consequences of external causes for people who were identified as being of Aboriginal or Torres Strait Islander origin
• Injuries to upper and lower limbs accounted for 41% of injury hospitalisations for Indigenous Australians (and 47% for Other Australians)
• Injuries to the head and neck accounted for  almost 1 in 4 (23%) injury hospitalisations for Indigenous Australians and just under 1 in 6 (16%) for Other Australians 
• Falls and  Assault were the most common reported causes of hospitalised injury for Indigenous Australians, with 2 in 5 injuries (21% and 18% respectively) listing these factors as one of the external cause of the injury
• Overall, Indigenous Australians were hospitalised at almost twice the rate of Other Australians (57 per 1,000 and 30 per 1,000 population, respectively) as a result of injury.

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 this care.

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. Hospitals are also required to report the number of continuous hours of ventilatory support (CVS) provided for each hospitalisation, either within an ICU, or in another location such as an emergency department. 

Highlights

Between 2019–20 and 2020–21:

• there was a increase in the number of hospitalisations involving ICU that reflected the overall increase in hospitalisations over this period
• the number of hospitalisations involving a stay in a level 3 ICU increased by 11%—from 140,400 to 156,400 hospitalisations, the change was most notable in private hospitals which increased by 4%, wheras public hospitals decreased by less than 1%
• the average duration of stay in level 3 ICUs decreased, which is mostly due to the increase in the average duration of stay in private hospitals (from 48 hours in 2019–20 to 42 hours in 2020–21).

Hours in intensive care provided to admitted patients

In 2020–21: 

• 12 million hours of care in level 3 ICUs were reported for 156,000 hospitalisations.

Public hospitals

• For every 1,000 hospitalisations, 15 involved a stay in a level 3 ICU
• 91 hospitals provided ICU care to 103,500 hospitalisations — equivalent to 9.7 million hours or 400,000 patient days
• The average duration of stay in ICU was 94 hours (3.9 days).

Private hospitals

• For every 1,000 hospitalisations, 11 involved a stay in a level 3 ICU.
• 52,450 hospitalisations spent a total of 2.2 million hours and 91,700 patient days in an ICU
• The average duration of stay in ICU was 42 hours per hospitalisation (1.8 days).

Hours of CVS provided to admitted patients in 2020–21

CVS is the use of invasive ventilatory support (through a endotracheal tube) and mechanical ventilation (a machine to assist breathing).

In 2020–21: 

• 4.3 million hours of CVS were reported for 45,800 hospitalisations.

Public hospitals

• 3.9 million hours (163,500 patient days) of CVS was provided to 38,000 hospitalisations
• For every 1,000 hospitalisations, 5 involved CVS  and the average duration of CVS was just under 105 hours per hospitalisation (4.4 days).

Private hospitals

• 340,300 hours (14,200 patient days) of CVS was provided for 8,100 hospitalisations
• For every 1,000 hospitalisations, 2 involved CVS and the average duration was just under 42 hours per hospitalisation (1.7 days).

Overlap between ICU care and CVS

CVS is usually, but not always, provided within an ICU. Most stays in ICU do not involve ventilatory support.

In 2020–21:

• 156,000 hospitalisations reported a stay in an ICU and of these, 37,500 reported a period of CVS
• 1 in 3 (30%) public hospitalisations that reported a stay in ICU also reported a period of CVS
• 12% of hospitalisations in private hospitals reporting a stay in ICU also reported a period of CVS
• Of the hosptialisations that did not involve a stay in ICU, a period of CVS was reported for 8,000.

The nature of the services provided to an admitted patient during an episode of care can be described in a number of ways including:

• the broad category of service
• Diagnosis Related Groups (AR-DRGs)—this includes the numbers of hospitalisations by Major Diagnostic Category (MDC) and AR-DRGs.

Broad category of service

Based on the type of care provided and the patient's main reason for requiring hospitalisation, hospitalisations are categorised into the following broad categories of service:

• Childbirth
• Mental health
• General intervention (Surgical)
• Medical
• Specific intervention (Other)
• Subacute and non-acute care.

See the 'More information about the data' section below for definitions of broad categories of service.

In 2020–21:

• over 1 in 2 (53%) of hospitalisations were for Medical care, 1 in 4 (24%) were for General intervention (Surgical) and over 1 in 10 (13%) for Specific intervention (Other)
• public hospitals accounted for 3 in 4 Medical hospitalisations (76%) and almost 4 in 5 Childbirth hospitalisations (78%)
• private hospitals accounted for 3 in 5 (60%) of surgical hospitalisations and mental health hospitalisations (62%).

Public hospitals

In 2020–21:

• 3 in 4 (75%) acute care hospitalisations (4.9 million) were Medical
• almost 1 in 5 (18%) acute care hospitalisations (1.2 million) were General intervention (Surgical) 
• Diseases and disorders of the kidney and urinary tract​ was the most common MDC  accounting for almost 1 in 4 (23%) of hospitalisations in public hospitals.

Private hospitals

In 2020–21:

• just over 2 in 5 (41%) acute care hospitalisations (1.7 million) were General intervention (Surgical) 
• just under 2 in 5 (37%) acute care hospitalisations (1.6 million) were Medical 
• Diseases and disorders of the digestive system was the most common MDC  accounting for almost 1 in 5 (18%) of hospitalisations in private hospitals.

Major diagnostic category (MDC) and Diagnostic related groups (AR-DRG)

Same-day acute care

In 2020–21:

• the 20 most common AR-DRGs accounted for almost 2 in 3 (65%) same-day acute hospitalisations
• almost 1 in 4 (23%) same-day acute hospitalisations were for Haemodialysis (dialysis), with Chemotherapy the next most common AR-DRG (9%)
• public hospitals provided 4 in 5 (79%) same-day acute hospitalisations for Haemodialysis (dialysis)
• private hospitals provided over 4 in 5 (83%) same-day acute hospitalisations for Retinal procedures and 86% of Dental extractions and restorations.

Overnight acute care

In 2020–21:

• Childbirth made up the top 3 AR-DRGs for overnight acute hospitalisations (Vaginal Delivery, Intermediate Complexity, followed by Vaginal Delivery, Minor Complexity and Caesarean Delivery, Minor Complexity. Most of these (80%, 79% and 60%, respectively) were in public hospitals
• private hospitals provided almost 4 in 5 (78%) overnight hospitalisations for Sleep Apnoea, Minor Complexity.

OECD indicators

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:

• Cataract surgeries
• Tonsillectomies

The number of:

• Caesarean sections per 100 live births
• Coronary revascularisation procedures per 100,000 population, and the proportion of these that were coronary angioplasties
• Hip replacement surgeries per 100,000 population
• Knee replacement surgeries per 100,000 population

The proportion of surgeries performed laparoscopically for:

• Cholecystectomies
• Appendicectomies
• Inguinal herniorrhaphies.

Highlights

Proportion of cataract surgeries that were performed on a same-day basis

A high proportion of cataract surgeries performed on a same-day basis may point to the efficient use of resources.

In 2020–21:

• the proportion of cataracts performed as same-day procedures in Australia (98%) was higher than the 2019 OECD average (90%).

Proportion of tonsillectomies that were performed on a same-day basis

In 2020–21:

• Australia’s proportion of tonsillectomies that were performed on a same-day basis (16%) was lower than the 2019 OECD average (38%).

​Number of caesarean sections per 100 live births

In 2020–21:

• Australia’s rate of caesarean sections per 100 live births (38.3) was higher than the 2019 OECD average (24.3).

Number of coronary revascularisation procedures per 100,000 population

The 2020–21:

• the Coronary revascularisation procedure rate for Australia was below the 2019 OECD average (196.8 and 256.1 per 100,000 population, respectively), and within the interquartile range
• Coronary angioplasty accounted for 79% of all Coronary revascularisation procedures in Australia, lower than the 2019 OECD average (86%).

Number of hip and knee replacement surgeries per 100,000 population

In 2020–21:

• Australia’s rate of hip replacement surgery was below the 2019 OECD average (173.0 and 193.9 per 100,000 population, respectively)
• Australia’s rate of knee replacement surgery was above the 2019 OECD average (216.5 and 137.4 per 100,000 population, respectively).

Proportion of selected surgical procedures that were performed laparoscopically

Laparoscopic (keyhole) surgery is less invasive (and therefore considered to be safer) than ‘open’ approaches.

In 2020–21, Australia had higher proportions of the 3 selected procedures that were performed laparoscopically:

• 95% of cholecystectomies in Australia were performed laparoscopically, compared with the 2019 OECD average (92%)
• 93% of appendicectomies in Australia were performed laparoscopically, compared with the 2019 OECD average (82%)
• 48% of inguinal herniorrhaphies in Australia were performed laparoscopically, compared with the 2019 OECD average (31%).