Admitted patient activity

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.

Explore the data

The data visualisations below present data on hospitalisations (by week of admission) for 2019–20, including:

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

Highlights

Decrease in overall hospitalisations in 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.

Public hospitals

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

• same-day hospitalisations decreased by 0.2% 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%
• Emergency admissions involving surgery increased by 0.6% and elective admissions involving surgery decreased by 8.3%

• 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%).

Private hospitals

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%
• Emergency admissions involving surgery increased by 0.8% and Elective admissions involving surgery decreased by 5.7%.

Weekly hospitalisation rates declined

From March to June 2020:

• there were 33,100 average daily hospitalisations that were admitted in the week commencing 2 March 2020, which gradually declined to 31,100 average daily hospitalisations that were admitted in the week commencing on 16 March
• average daily hospitalisations sharply decreased to 19,900 in the week commencing on 6 April—an overall decrease of 40% between 2 March and 6 April 2020
• the average daily hospitalisations then steadily increased between 6 April to 22 June, though were still lower than the comparable period in 2019
• in the week beginning 22 June, there were, on average, 28,500 daily hospitalisations when hospital activity had begun to operate at a comparable rate to the same period in 2018–19.

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.

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).

Explore the data

The data visualisations below show hospitalisations involving a COVID-19 diagnosis that occurred between 1 July 2019 and 30 June 2020, including by:

• sex and age
• Indigenous status
• remoteness of area of usual residence
• socioeconomic status of area of usual residence
• separations involving a stay in ICU and/or CVS hours
• comorbid chronic conditions.

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

How many hospitalisations were there involving a COVID-19 diagnosis?

Nationally, in 2019–20:

• there were around 2,600 hospitalisations involving a COVID-19 diagnosis, including 2,500 hospitalisations where the COVID-19 virus was identified (U07.1–COVID-19, virus identified) and 150 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 87 days (nearly 3 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 2019–20:

• 65% of hospitalisations were for people aged 45 or older
• only 3.0% of hospitalisations were for infants or young children, aged 0–14.

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%).

Where did patients with a COVID-19 diagnosis live?

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:

• the majority of hospitalisations (75%, or 1,970 separations) involving a COVID-19 diagnosis were for people living in Major cities and Inner regional areas (13%, or 340 separations)
• less than 1% of hospitalisations involving a COVID-19 diagnosis were for patients who usually lived in in Remote and Very Remote areas
• nearly half (49%) of hospitalisations involving a COVID-19 diagnosis were for patients living in areas classified as the two highest socioeconomic status groups (least disadvantaged)
• 95% of hospitalisations involving a COVID-19 diagnosis were for non-Indigenous Australians and only 1.2% of separations 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 2019–20, of the 2,600 hospitalisations involving a COVID-19 diagnosis:

• 8.6% of hospitalisations involved a stay in ICU, during which patients received an average of 138 hours in ICU care
• 5.3% of hospitalisations involved CVS
• 4.0% 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 '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.

Comorbid chronic conditions

In 2019–20, of the 2,600 hospitalisations involving a COVID-19 diagnosis:

• most hospitalisations (74%) involving a COVID-19 diagnosis had no comorbid chronic condition recorded
• 18% of hospitalisations involving a COVID-19 diagnosis had one comorbid chronic comorbid condition recorded
• 7.3% of hospitalisations involving a COVID-19 diagnosis had two or more chronic comorbid conditions recorded.

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:

• 19% of hospitalisations involved time spent in ICU
• 13% involved CVS
• 8.6% had separation mode indicating the patient died in hospital.

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

• 36% of hospitalisations involved time spent in ICU
• 31% involved CVS
• 20% 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 involving no comorbid chronic conditions recorded:

• 3.2% hospitalisations involved time spent in ICU
• less than 1% involved CVS
• less than 2% 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 (13%) and Type 2 diabetes (10%).

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

• 39% of hospitalisations involved time spent in ICU
• 31% involved CVS
• 14% had a separation mode indicating the patient died in hospital.

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

• 24% of hospitalisations involved time spent in ICU
• 19% involved CVS
• 11% had a separation mode indicating the patient died in hospital.

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 2015–16 and 2019–20.

Highlights

Hospitalisations

In 2019–20: 

• hospitalisations decreased by 2.8% since 2018–19—from 11.5 to 11.1 million hospitalisations in Australia’s public and private hospitals
• the largest decrease was in private hospitalisations (4.5%) compared to public hospitalisations (1.7%)
• overnight hospitalisations decreased by 4.0% and same-day hospitalisations decreased by 2.1%.

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:

• between 2017–18 and 2018–19, the number of hospitalisations rose by 2.6%—by 3.0% for public hospitals and by 2.0% for private hospitals
• from 2014–15 to 2018–19, hospital admissions increased by 3.3%, on average, each year.

Patient days

In 2019–20:

• public hospitals accounted for 67% of patient days (20.5 million)

• 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.

Changes over time

Between 2018–19 and 2019–20:

• the number of patient days decreased by 2.2%—from 30.9 million to 30.2 million patient days
• the number of patient days in private hospitals decreased by 3.7% and patient days in public hospitals decreased by 1.4%
• the rate of patient days in public hospitals went from 754 per 1,000 population in 2018–19 to 728 per 1,000 population in 2019–20
• the rate of patient days in Public psychiatric hospitals increased by 9.2%—from 20.8 to 22.7 per 1,000 population.

Coverage changes in public hospitals from 2018–19 to 2019–20 may influence changes over time.

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. 

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 2019–20, 669 public hospitals in Australia provided admitted patient care services—

• 31 Principal referral hospitals accounted for the highest proportion of public hospital separations (2.5 million separations, or 37%) and public hospital patient days (7.7 million patient days, or 38%)
• 63 Public acute group A hospitals accounted for a further 35% of separations and 32% of patient days
• 109 Very small hospitals accounted for less than 1% of both separations and patient days, with an average length of stay of 10.6 days which was much longer than the average length of stay in Principal referral hospitals
• 36 Subacute and non-acute hospitals accounted for 0.9% of separations and 4.1% of patient days, with an average length of stay of 13.1 days.

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:

• 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 2015–16 and 2019–20, and by hospital, between 2011–12 to 2019–20.

Highlights

In 2019–20, for the public and private sectors combined:

• 91% of hospitalisations were classified as episodes of Acute care
• 3.7% of hospitalisations were classified as episodes of as Rehabilitation care
• 3.2% of hospitalisations were classified as episodes of as Mental health care
• 0.7% of hospitalisations 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 62% of hospitalisations for Acute care, while private hospitals accounted for 79% of hospitalisations for Rehabilitation care.

Acute care

In 2019–20:

• the most common principal diagnosis (at the 3-character level) reported for same-day acute hospitalisations was Care involving dialysis which accounted for 34% of same-day acute hospitalisations in public hospitals
• the most common principal diagnosis (at the 3-chartacter level) reported for overnight acute hospitalisations was Single spontaneous delivery which accounted for 3.2% of hospitalisations in public and private hospitals.

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.

Newborn care

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.

In 2019–20:

• there were 76,300 hospitalisations for newborn care with at least one qualified day—the majority of these (86%) occurred in public hospitals
• the most common diagnosis for newborns with at least one qualified day was Disorders related to short gestation and low birth weight, not elsewhere classified (27% of hospitalisations for qualified newborns) followed by Respiratory distress of newborn (13% of hospitalisations for qualified newborns).

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:

• for qualified newborns, Newborn care hospitalisations increased by 3.6% in public hospitals and decreased by 5.3% in private hospitals
• for unqualified newborns, Newborn care hospitalisations decreased by 1.8% for public hospitals and 2.8% for private hospitals.

Subacute and non-acute care

Between 2018–19 and 2019–20:

• there were 550,500 hospitalisations for Subacute and non-acute care
• the number of hospitalisations for Subacute and non-acute care decreased by 1.7% in public hospitals and 12% in private hospitals.

Rehabilitation care

In 2019–20:

• there were over 417,400 Rehabilitation care hospitalisations, with the majority (79%) occurring in private hospitals
• Rehabilitation care accounted for 94% of Subacute and non-acute care hospitalisations for private hospitals and 44% 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 (7.4 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 (13.1 hospitalisations per 1,000 population compared to 10.7 per 1,000 nationally)
• half (50%, 210,000) 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 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

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 2019–20:

• there were over 49,000 hospitalisations with a care type of Palliative care, the majority (86%) of these occurred in public hospitals
• neoplasm-related (cancer-related) conditions accounted for 52% of principal diagnoses reported for Palliative care hospitalisations, 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 Heart failure and Other chronic obstructive pulmonary disease.

 Between 2018–19 and 2019–20:

• Palliative care hospitalisations increased by 2.5% in private hospitals and 2.9% for public hospitals
• Palliative care hospitalisations accounted for less than 0.5% of all hospital hospitalisations.

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 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.

In 2019–20:

• there were 360,000 Mental health care hospitalisations, with the majority (60%) occurring in private hospitals
• the majority (86%) of Mental health care hospitalisations in public hospitals involved a stay of at least one night
• for private hospitals, the majority (77%) of Mental health care hospitalisations were for same-day care
• females accounted for more than half (58%) of all Mental health care hospitalisations

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.

Highlights

ICD-10-AM chapters

In 2019–20:

• one-quarter (25%, 2.7 million) of hospitalisations in public and private hospitals 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 1.5 million separations), radiotherapy and chemotherapy
• the relative distribution of hospitalisations by ICD-10-AM chapter varied across public and private hospitals. For example, about 85% of hospitalisations for both Certain infectious and parasitic diseases and Certain conditions originating in the perinatal period were from public hospitals. For Diseases of the eye and adnexa, about 73% of hospitalisations were from private hospitals
• about 48% of 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 23% for Other Australians
• the ICD-10-AM chapter Injury, poisoning and certain other consequences of external causes was the second most common principal diagnosis chapter among Indigenous Australians, accounting for 6.7% of hospitalisations. It accounted for 7.0% of hospitalisations for Other Australians
• separation rates for Indigenous Australians were 6.1 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

Same-day acute separations

In 2019–20:

• the most common principal diagnosis (at the 3-character level) reported for same-day acute separations was Care involving dialysis, which accounted for 34% of same-day acute separations in public hospitals
• public hospitals provided the majority of same-day acute separations for Pain in throat and chest (92%) and Care involving dialysis (79%)
• private hospitals provided the majority of same-day acute separations for Embedded and impacted teeth (94%), Procreative management (93%), Other retinal disorders (89%), and Benign neoplasm of colon, rectum, anus and anal canal (79%). The principal diagnoses Gastro-oesophageal reflux disease (73%) and Other cataract (73%) also contributed to high counts of private hospital same-day acute separations.

Overnight acute separations

In 2019–20:

• public hospitals provided the majority of overnight acute separations (2.8 million or 72%)
• the most common principal diagnosis (at the 3-character level) reported for overnight acute separations was Single spontaneous delivery, which accounted for 3.7% of overnight acute separations in public hospitals and 1.9% in private hospitals
• private hospitals provided a large majority of overnight acute separations for Cellulitis (71%), Coxarthrosis (arthrosis of hip, 69%), Sleep disorders (64%), and Chronic ischaemic heart disease (67%).

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.

Highlights

In 2019–20:

• 23.9 million interventions were reported—with 12.6 million performed in public hospitals and 11.3 million in private hospitals
• 77% (5.2 million) of public hospital separations and 95% (4.2 million) of private hospital separations involved at least one intervention
• public hospitals accounted for 79% of Obstetric procedures (which includes childbirth), 78% of Procedures on the respiratory system, 76% of Radiation oncology procedures and 72% of Procedures on the urinary system (mainly for dialysis)
• private hospitals accounted for 78% of Dental services procedures, 76% of Procedures on nervous system and 70% of Procedures on breast. 

Interventions for same-day acute care

In 2019–20:

• 10.6 million interventions were reported
• 79% of separations in public hospitals and 99% of separations in private hospitals involved an intervention
• Cerebral anaesthesia (general anaesthesia and sedation, 2.3 million procedures), Haemodialysis (1.5 million) and Administration of pharmacotherapy (mostly chemotherapy, 1 million) accounted for 46% of all procedures.

Interventions overnight acute care

In 2019–20:

• 10.8 million interventions were reported
• 74% of separations in public hospitals and 89% of separations in private hospitals involved at least one intervention
• Generalised allied health interventions (for example, physiotherapy and other rehabilitation procedures) accounted for 41% of interventions in public hospitals (3.0 million).

Surgery

This section presents information on all surgical separations (operating room procedures). 

In 2019–20:

• nearly 1 in 4 hospitalisations (24%) involved surgery and 58% of these occurred in private hospitals
• there were 367,600 emergency admissions involving surgery and 87% of these occurred in public hospitals. The most common emergency surgery performed was Other, followed by Acute appendicitis
• there were 2.1 million elective admissions involving surgery and 67% of these occurred in private hospitals.  

Surgical separations

In 2019–20:

• a surgical procedure was reported for 24% of all separations (2.6 million)—17% of public hospital separations and 34% of private hospital separations
• 5% of surgical separations had an urgency of admission of Not assigned (for example, for childbirth or other planned procedures) or not reported
• for public hospitals, 64% of surgical separations were elective admissions, 28% were emergency admissions and 8% did not have an urgency assigned
• for private hospitals, 95% of surgical separations were elective admissions and 3% were emergency admissions and 2% did not have an urgency assigned.

Emergency admissions involving surgery

In 2019–20:

• there were 367,600 emergency admissions involving 683,900 surgical interventions in Australian hospitals
• there were 13.7 emergency admissions involving surgery per 1,000 population 
• public hospitals accounted for the majority (87%) of emergency admissions involving surgery
• Other debridement of skin and subcutaneous tissue was the most common surgical intervention (at the procedure block level) for emergency admissions involving surgery, and 91% of these were performed in public hospitals.

Elective admissions involving surgery

In 2019–20:

• there were 2.1 million Elective admissions involving surgery in Australia’s public and private hospitals
• the rate of Elective admissions involving surgery was 78 per 1,000 population
• the rate of Elective admissions involving surgery was 26 per 1,000 population for public hospitals and and 52 per 1,000 population for private hospitals 
• the most common principal diagnosis was Other cataract (206,300 or 10%), with 72% of these occurring in private hospitals
• 94% of admissions with a principal diagnosis of Procreative management and a principal diagnosis of Obesity and overweight were in private hospitals
• half (50%) of admissions with a principal diagnosis of Cholelithiasis (gallstones) occurred in public 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 2019–209. The information is also presented by:

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

Highlights

In 2019–20:

• 779,100 hospitalisations (about 29 per 1,000 population) had a principal diagnosis of Injury, poisoning and certain other consequences of external causes—the majority (78%) were treated in public hospitals
• 46% of these hospitalisations, in public and private hospitals combined, had a principal diagnosis of Injuries to upper and lower limbs 
• public hospitals had notably higher proportions (96% or more) of hospitalisations with external causes of Intentional self-harm, Assault, Accidental poisoning, and Accidental drowning and submersion, than private hospitals
• Falls (38%, 296,400 hospitalisations) and Complications of medical and surgical care (17%, 132,300 hospitalisations) were the most frequently reported external causes of injury or poisoning.

Aboriginal and Torres Strait Islander Australians

In 2019–20:

• Aboriginal and Torres Strait Islander Australians were hospitalised with a principal diagnosis of Injury, poisoning and certain other consequences of external causes at almost twice the rate of Other Australians (53 per 1,000 and 28 per 1,000, respectively)
• Injuries to upper and lower limbs accounted for 41% of these hospitalisations for Indigenous Australians and 46% for Other Australians
• Injuries to the head and neck accounted for 23% of hospitalisations for Indigenous Australians and 16% for Other Australians 
• Falls (20%) and Assault (19%) were the most commonly reported external cause of injury and poisoning for Indigenous Australians, accounting for 39% of all reported external causes of injury and poisoning
• Transport accidents accounted for a similar proportion of external causes of injury for both Indigenous Australians and Other Australians (about 9% each).

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. 

Highlights

Hospitalisations involving ICU

Between 2018–19 and 2019–20:

• there was a decrease in the number of hospitalisations involving ICU that reflected the overall decrease in hospitalisations over this period
• the number of separations involving a stay in a level 3 ICU decreased by 24%—from around 185,900 separations to 140,400 separations in 2019–20
• the change was most notable in private hospitals compared to public hospitals (which decreased by 47% and 11%, respectively)
• the average duration of stay in level 3 ICU increased, which is mostly due to the increase in the average duration of stay in private hospitals (from 36.7 hours in 2018–19 to 47.8 hours in 2019–20).

Hours in intensive care

For public hospitals in 2019–20:

• there were 15.5 separations that involved a stay in ICU per 1,000 separations
• 9.6 million hours (or nearly 400,000 patient days) were spent in an ICU for 104,100 hospitalisations
• the average duration of stay in ICU was 92 hours per hospitalisation (nearly 4 days).

For private hospitals in 2019–20:

• data was only available for New South Wales, Victoria, Queensland, Western Australia and South Australia
• there were 8.3 separations that involved a stay in ICU per 1,000 separations
• 1.7 million hours (72,500 patient days) were spent in an ICU for 36,400 hospitalisations
• the average duration of stay in ICU was 48 hours per hospitalisation (2 days).

Hours of continuous ventilatory support

Continuous ventilatory support (CVS) refers to the use of invasive ventilatory support or mechanical ventilation (a machine to assist breathing).

In 2019–20: 

• 4.3 million hours of CVS were reported for 46,600 hospitalisations in Australian hospitals.

For public hospitals in 2019–20:

• 3.9 million hours (163,500 patient days) of CVS for 39,000 hospitalisations
• 5.8 separations involved CVS per 1,000 separations and the average duration of CVS was 101 hours per separation (over 4 days).

For private hospitals in 2019–20:

• data was only available for New South Wales, Victoria, Queensland, Western Australia and South Australia
• 351,400 hours (14,600 patient days) of CVS was provided for 7,700 hospitalisations
• 1.7 separations involved CVS per 1,000 separations and the average duration of CVS was 46 hours per separation (just under 2 days).

Overlap between ICU and CVS

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

In 2019–20:

• 140,400 hospitalisations reported a stay in an ICU and 46,600 hospitalisations reported a period of CVS
• of the hospitalisations that involved a stay in an ICU, 26% of hospitalisations (or (36,600 of 140,000) also involved hours of CVS—23% for public hospitals and 3.1% for private hospitals
• of the hospitalisations that involved CVS, 78% of hospitalisations (or 36,600 of 46,600) also reported a stay in an ICU.

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
• the Australian Refined Diagnosis Related Groups (AR-DRGs)—this includes the numbers of hospitalisations by Major Diagnostic Category (MDC) and AR-DRGs
• the intent of care—including who used these services, why they received care, how the care was completed and who paid for the care.

Highlights

Broad category of service

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 more information on broad category of service.

In 2019–20:

• 55% of hospitalisations were for Medical care, 23% were for General intervention (Surgical) and 12% for Specific intervention (Other)
• public hospitals accounted for the majority of Emergency hospitalisations (92%), Medical hospitalisations (76%) and Childbirth hospitalisations (78%)
• private hospitals accounted for 59% of surgical hospitalisations and 60% of mental health hospitalisations 
• Emergency hospitalisations in public hospitals had shorter stays (4.3 days, on average) compared with Emergency hospitalisations in private hospitals (6.1 days)
• for Childbirth hospitalisations, Emergency surgery and Medical emergency hospitalisations, the average lengths of stay were longer in private hospitals than in public hospitals.

In 2019–20, for public hospitals:

• Medical DRGs accounted for 76% of acute care hospitalisations (4.8 million)
• Surgical DRGs accounted for 18% of acute care hospitalisations (1.1 million)
• Diseases and disorders of the kidney and urinary tract was the most common MDC for public hospitals (23% of acute care hospitalisations).

In 2019–20, for private hospitals:

• Surgical DRGs accounted for 39% of acute care hospitalisations (1.5 million)
• Medical DRGs accounted for 39% of acute care hospitalisations (1.5 million)
• Diseases and disorders of the digestive system was the most common MDC (17%) for private hospitals
• Private hospitals accounted for 71% of acute care hospitalisations for Diseases and disorders of the eye.

Changes over time

Between 2015–16 and 2019–20:

• in public hospitals, Emergency surgical hospitalisations increased by an average of 2.5% each year, and Emergency medical hospitalisations increased by an average of 1.7% each year
• in private hospitals, Non-emergency medical hospitalisations increased by an average of 2.3% each year.

Between 2018–19 and 2019–20:

• Emergency hospitalisations decreased by 2.8% in public hospitals and by 3.3% in private hospitals. 

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’.

Major diagnostic category (MDC) and AR-DRG

Same-day acute care

In 2019–20:

• the 20 most common AR-DRGs accounted for almost two-thirds (65%) of same-day acute hospitalisations
• almost one-quarter (24%) of same-day acute hospitalisations were for Haemodialysis (dialysis), with Chemotherapy the next most common AR-DRG (10%)
• public hospitals provided the majority (79%) of same-day acute hospitalisations for Haemodialysis (dialysis)
• private hospitals provided 85% of same-day acute hospitalisations for Retinal procedures and 85% of Dental extractions and restorations.

Overnight acute care

In 2019–20:

• the 2 most common AR-DRGs for overnight acute hospitalisations were for Vaginal Delivery, Intermediate Complexity, followed by Respiratory Infections and Inflammations, Major Complexity
• public hospitals provided the majority of overnight hospitalisations for Vaginal delivery, intermediate complexity and Vaginal delivery, minor complexity (81% and 79%, respectively)
• private hospitals provided 75% of overnight hospitalisations for Sleep Apnoea, Minor Complexity and 84% of overnight hospitalisations for Other Shoulder Procedures.

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
• Inguinal herniorrhaphies
• Appendicectomies

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 2019–20:

• the proportion of cataracts performed as same-day procedures in Australia (97.6%) was higher than the 2018 OECD average (74.1%).

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

In 2019–20:

• Australia’s proportion of tonsillectomies that were performed on a same-day basis (14.4%) was lower than the 2018 OECD average (34.9%).

​Number of caesarean sections per 100 live births

In 2019–20:

• Australia’s rate of caesarean sections per 100 live births (36.8) was higher than the 2018 OECD average (26.7).

Number of coronary revascularisation procedures per 100,000 population

The 2019–20:

• the Coronary revascularisation procedure rate for Australia was below the 2018 OECD average (195.2 and 230.1 per 100,000 population, respectively), and within the interquartile range
• Coronary angioplasty accounted for 78.6% of all Coronary revascularisation procedures in Australia, lower than the 2018 OECD countries’ average (81.2%).

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

In 2019–20:

• Australia’s rate of hip replacement surgery in 2019–20 was below the 2018 OECD average (151.5 and 178.3 per 100,000 population, respectively)
• Australia’s rate of knee replacement surgery was above the 2018 OECD average (180.2 and 140.7 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 2019–20, Australia had higher proportions of the 3 selected procedures that were performed laparoscopically:

• 94.6% of cholecystectomies in Australia were performed laparoscopically, compared with the 2018 OECD average (89.3%)
• 92.8% of appendicectomies in Australia were performed laparoscopically, compared with the 2018 OECD average (68.5%)
• 46.8% of cholecystectomies in Australia were performed laparoscopically, compared with the 2018 OECD average (31.4%).