WA Country Health Service

An emergency department (ED) presentation occurs following the arrival of the patient at the ED, and commences at the point of being registered clinically or triaged.

Explore the data

Explore the number of presentations to Australia’s public hospital EDs between 2016–17 and 2020–21 in the data visualisation below.

Information is presented by:

• age and sex
• Indigenous status.

The data can also be explored by:

• overall national trends
• state and territory
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

• There were 8,808,357 presentations to Australian emergency departments in 2020–21.
• Most presentations to emergency departments occurred in Principal referral and women’s and children’s and Public acute group A hospitals (72%).
• On average, emergency department presentations have increased 3.2% per year since 2016–17.

Age and sex

• ED presentations were generally evenly split between males and females. However, for those aged 0–14, substantially more were boys (55%) than girls (45%) in 2020–21.
• The highest presentation rate per 1,000 population (crude rate) was for patients aged over 85,1649 per 1,000 population)
• The second highest presentation rate per 1,000 population (crude rate) was for patients aged 4 and under (1,140 per 1,000 population).

Indigenous status

• About 7.5% of ED presentations (616,000) were for Aboriginal and Torres Strait Islander people, who represent about 3.4% of the Australian population.
• In all jurisdictions, and across all age groups, the presentation rate per 1,000 population was greater for Indigenous Australians compared to Other Australians.

Remoteness area of usual residence 

• People living in Major cities (who make up 72% of the Australian population), accounted for 63% of ED presentations—298 presentations per 1,000 people.
• People living in Remote and Very remote areas (who make up 2% of the population) accounted for 3.5% of presentations.

Socioeconomic status of area of usual residence

• People living in the second lowest (second most disadvantaged) areas accounted for 23% of ED presentations—392 presentations per 1,000 people.
• People living in the highest (least disadvantaged) areas were the least likely to visit an ED. They accounted for 15% of all ED presentations—260 presentations per 1,000 people.

Emergency department (ED) waiting time is the time elapsed for each patient from presentation in the ED to commencement of clinical care.

A patient is considered to be 'seen on time' when the time between arrival at the ED and the time that their clinical care starts is within the time specified in the definition of the triage category they are assigned:

• Resuscitation: Immediate (within seconds)
• Emergency: within 10 minutes
• Urgent: within 30 minutes
• Semi-urgent: within 60 minutes
• Non-urgent: within 120 minutes.

Explore the data

The data visualisation below present the following emergency department waiting time statistics:

• Proportion seen on time
• 50th percentile (median) waiting time
• 90th percentile waiting time

The data is presented by:

• Triage category

By selecting a geography in the visualisation below, the data can also be explored by:

• Overall national trends
• State and territory
• Hospital (where data is available)
• Local Hospital Network (LHN) (where data is available).

Highlights

Proportion of patients seen on time has decreased

In 2020–21:

• The proportion of patients ‘seen on time’ was 71%, down from 74% in 2019–20.
• Principal referral and Women’s and children’s hospitals and Public acute group A hospitals had the lowest overall proportion of presentations ‘seen on time’ (both 68%), and Other hospitals had the highest proportion (90%).
• 50% of patients were seen within 18 minutes, which was slightly slower than the previous year (17 minutes), but faster than the preceding 3 years (19 minutes).
• The time within which 90% of presentations were seen was 1 hour and 42 minutes.

An emergency department (ED) stay is the period between a patient presenting at an ED, and when that person is recorded as having physically departed the ED (regardless of whether they were admitted, referred, discharged or left at their own risk).

Explore the data

The data visualisation below presents the following measures related to time spent in the emergency department:

• proportion of patients with a length of stay of 4 hours or less
• 50th percentile (median) time spent in the ED
• 90th percentile time spent in the ED.

The data is presented by:

• state and territory
• admission status
• triage category
• peer group.

The data can also be explored by:

• trends over time
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2020–21:

• 90% of ED presentations were completed within 8 hours, and 50% were completed within 3 hours and 1 minute
• 90% of patients who were subsequently admitted to the same hospital spent more time in the ED (12 hours 57 minutes) than patients who were not admitted (5 hours 53 minutes)
• 67% of patients had their care completed within 4 hours
• for patients subsequently admitted to the same hospital, less than half (42%) of ED presentations were completed within 4 hours
• for patients not subsequently admitted, 77% of ED presentations were completed within 4 hours.

Elective surgery waiting list activity is measured by the number of additions to and removals from public hospital elective surgery waiting lists, and the number of patients admitted for their awaited procedure.

Explore the data

The data visualisation below presents information on additions, removals and admissions in 2020–21 and changes over recent years.

The data can also be explored by:

• overall national trends
• state and territory
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In  2020–21, admissions from elective surgery waiting lists increased overall by 9.6%. This followed a 9.2% reduction in admissions in 2019–20 due to national restrictions placed on elective surgery associated with the outbreak of COVID-19. This is in contrast with preceding years when admissions from elective surgery waiting lists had been increasing—for example, between 2014–15 and 2018–19, admissions increased, on average, by 2.1% per year.

The change in elective surgery admissions in 2020–21, however, was not uniform across the country—changes ranged from a 21% increase in NSW to a 5.8% decrease in Victoria associated with prolonged restrictions. 

Overall in 2020–21:

• There were 754,600 admissions from public hospital elective surgery waiting lists—99% of which were elective admissions for the awaited procedure. The remaining 1% were admitted as emergency patients because the patient’s condition deteriorated or for other reasons.
• Principal referral and women’s and children’s hospitals and Public acute group A hospitals accounted for three‑quarters of all admissions from elective surgery waiting lists (41% and 35%, respectively).
• 4.1% of admissions from public hospital elective surgery waiting lists were reported for people of Aboriginal and Torres Strait Islander origin who represent 3.3% of the Australian population.

Additions

In 2020–21, 893,163 patients were added to elective surgery waiting lists in Australia—a 6.6% increase over the number of patients added in 2019–20. However, it should be noted that:

• The number of patients added in 2019–20 (837,839) was a 7.1% reduction in the number of additions in the previous year and was affected by restrictions placed on elective surgery and healthcare services more generally.
• In the 5 years to 2018–19, the number of additions to elective surgery waiting lists increased, on average by 2.5% each year.

Removals

In 2020–21:

• 906,525 patients were removed from public hospital elective surgery waiting lists, which was an increase of 11% since 2019–20.
• Most patients (83%) removed from waiting lists were admitted for their awaited procedure.
• 17% were removed from waiting lists for other reasons (for example, the surgery was no longer required, they were treated elsewhere, transferred to another hospital’s waiting list, were unable to be contacted, or died).

The 11% increase in removals in 2020–21 followed an 8.0% decrease in the number of removals between 2018–19 and 2019–20 due to restrictions on elective surgery due to COVID-19. In prior years (between 2014–15 and 2018–19), the total number of removals from public hospital elective surgery waiting lists increased, on average, by 2.3% each year.

Between 2018–19 and 2019–20 there was a 20% increase in patients removed from elective surgery waiting lists due to being transferred to another hospital’s waiting list. This number increased again by 40% between 2019–20 and 2020–21 possibly due, in part, to management of waiting lists during COVID-19.

The surgical speciality describes the area of clinical expertise held by the doctor performing the elective surgery. This section presents information on the type of elective surgery provided, by surgical speciality, in 2020–21 and changes over recent years.

Information on 11 categories of surgical speciality is presented. The ‘other’ category contains data for surgeons whose speciality was not one of the 11 specified categories. From 1 July 2016, surgical speciality was revised to include Paediatric surgery.

The data visualisation below presents information on admissions from elective surgery waiting list by state and territory in 2020–21 and for recent years.

The data can also be explored by:

• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2020–21:

• 20% of patients were admitted for General surgery (on abdominal organs, including endocrine surgery and breast surgery). This was the most common surgical specialty following admission from a waiting list.
• 15% were admitted for Urological surgery (on organs of the urinary system such as bladder, urethra and kidneys) and 14% were admitted for Orthopaedic surgery (on bones, joints, ligaments and tendons, including knee and hip replacements).

Changes over time

Between 2018–19 and 2019–20 there was an overall decrease in admissions for elective surgery across all surgical specialities due to restrictions on elective surgery implemented due to COVID-19 pandemic.

In 2020–21, as restrictions eased in most jurisdictions, there was an increase in admissions for elective surgery across all surgical specialties with the exception of Cardiothoracic surgery. In general, those surgical specialties with the largest decreases between 2018–19 and 2019–20 had the greatest increase in admissions between 2019–20 and 2020–21.

The continuation of restrictions on elective surgery admissions across some jurisdictions in 2020–21 due to the COVID-19 pandemic should be taken into account when interpreting this data.

Between 2019–20 and 2020–21:

• admissions from elective surgery waiting lists increased for 10 of the 11 surgical specialities
• Paediatric surgery and Ophthalmology surgery had the largest increase in admissions, 17% and 18% respectively
• Cardiothoracic surgery decreased 4.4%.

The intended surgical procedure describes the type of surgery for which a patient has been placed on a public hospital elective surgery waiting list. In some instances, the intended procedure may not reflect what was actually performed during the hospitalisation.

Explore the data

In the data visualisations below, you can explore data about admissions from elective surgery waiting lists for 15 indicator procedures and ‘other’ procedures for 2020–21 and other recent years by:

• Overall national trends and state/territory
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2020–21:

• the 15 indicator procedures accounted for 35% of admissions
• Cataract extraction was the most commonly reported intended surgical procedure with 73,100 patients admitted, followed by Cystoscopy with 67,500 patients admitted.

Changes over time

Following decreases in admissions for most procedures between 2018–19 and 2019–20, admissions for most indicator procedures increased in 2020–21.

Between 2019–20 and 2020–21:

• admissions from elective surgery waiting lists increased for most indicator procedures with the exception of Myringotomy (which decreased 15%) and Coronary artery bypass surgery (which decreased 12%)
• the two procedures with the greatest increase in admissions were Septoplasty (which increased 32%) and Total knee replacement (27% increase).

Waiting times data provides information about the length of time waited by patients on public hospital elective surgery waiting lists before being admitted for surgery.

Explore the data

In the data visualisation below, you can explore waiting times for elective surgery by hospital peer group and clinical urgency category of the surgery for 2020–21 and other recent years

The data can also be explored by:

• hospital (where data is available)
• Local Hospital Network (LHN) (where data is available).

Highlights

In 2020–21:

• the overall time within which 50% of patients were admitted (the median waiting time) was 48 days, and the time within which 90% of patients were admitted was 348 days
• 7.6% of patients waited more than 365 days for their surgery
• the 50th percentile (median) waiting time for patients admitted from waiting lists to Principal referral and Women’s and children’s hospitals (37 days) was shorter than for smaller hospitals categorised as Public acute group A hospitals and Public acute group B hospitals (53 days and 65 days, respectively).

Changes over time

Between 2019–20 and 2020–21, increases in the 50th and 90th percentile waiting times occurred across all states/territories. This is likely due to restrictions put in place for certain elective surgeries during 2019–20 in response to COVID-19, which resulted in delays in many types of elective surgery.

50th percentile (median) waiting time

Between 2016–17 and 2020–21, the 50th percentile waiting time:

• increased overall from 38 days to 48 days
• increased for all public hospital peer groups.

90th percentile waiting time

Between 2016–17 and 2020–21, the 90th percentile waiting time:

• increased overall from 258 days to 348 days.

Patients who waited more than 365 days

Between 2019–20 and 2020–21, the proportion of patients who waited more than 365 days to be admitted increased from 2.8% to 7.6%. Prior to 2020–21, this proportion fluctuated between 1.7% to 2.8%.

Waiting times by clinical urgency category

When a patient is placed on a public hospital elective surgery waiting list, a clinical assessment is made of the urgency with which they require elective surgery (the clinically recommended time). The proportion of patients seen within the recommended time is the percentage of patients who were admitted for surgery within the clinically recommended time for each clinical urgency category.

The ‘overdue wait’ is the amount of time spent waiting while overdue—that is, after 30, 90 or 365 days for clinical urgency categories 1, 2 and 3, respectively. The average overdue wait time (in days) is calculated for patients who were still waiting for their elective surgery as at 30 June 2021, who were ready for care, and who had waited beyond the recommended time.

Due to the lack of comparability of clinical urgency categories between states and territories, these data are presented for each state and territory separately.

In 2020–21:

• for New South Wales, 85% of patients were admitted within the clinically recommended time
• for Victoria; 80%
• for Queensland; 88%
• for Western Australia; 84%
• for South Australia; 74%
• for Tasmania; 48%
• for the Australian Capital Territory; 77%
• for the Northern Territory; 71%.

The surgical speciality describes the area of clinical expertise held by the doctor performing the elective surgery.

Between 2016–17 and 2019–20, median waiting times for elective surgeries tended to remain relatively stable across most surgical specialties. However, at the end of the 2019–20 period, a range of measures were introduced in response to COVID-19, including restrictions on the elective surgeries that were able to be performed. This has impacted 2020–21 elective surgery waiting times across most surgical specialties.

Explore the data

In the data visualisation below, you can explore elective surgery waiting times by surgical speciality for 2020–21 and for other recent years.

In the data visualisations below, you can explore elective surgery waiting times for 2020–21 and other recent years by:

• the list of 11 surgical specialties
• state and territory
• Local Hospital Network (LHN), and hospital level.

Highlights

In 2020–21:

• the surgical speciality with the highest median waiting time was Ophthalmology (118 days)
• the surgical speciality with the lowest 50th and 90th percentile waiting time was Cardiothoracic surgery (18 days and 86 days respectively)
• the surgical specialities that had the highest proportions of patients who waited more than 365 days to be admitted were Otolaryngology, head and neck surgery and Orthopaedic surgery (17% and 15%, respectively).

Changes over time

Between 2019–20 and 2020–21:

• waiting times increased substantially at both the 50th and 90th percentiles for surgeries conducted in 7 of the 12 surgical specialty categories
• across 4 of the surgical speciality categories, median waiting times remained similar to recent years but increased substantially at the 90th percentile
• waiting times remained similar to recent years in just one surgical speciality area (Cardio-thoracic surgery).

Waiting list statistics for intended surgical procedures can indicate performance in particular areas of elective surgery. Information on the types of elective surgery provided by public hospitals is shown by the intended surgical procedure, for selected procedures only.

Between 2016–17 and 2019–20, median waiting times for elective surgeries tended to remain relatively stable across most surgical specialties. However, at the end of the 2019–20 period, a range of measures were introduced in response to COVID-19, including restrictions on the elective surgeries that were able to be performed. This has impacted 2020–21 elective surgery waiting times across most procedures.

Explore the data

In the data visualisations below, you can explore elective surgery waiting times for 2020–21 and other recent years by:

• the list of 15 indicator procedures
• state and territory
• Local Hospital Network (LHN), and hospital level (for all intended procedures).

Highlights

In 2020–21, for the top 25 intended procedures:

• Breast lump excision and/or biopsy had the shortest median and 90th percentile waiting times: the median waiting time was 16 days, the 90th percentile waiting time was 48 days, and the proportion of patients who waited more than 365 days was among the lowest (0.4%).
• Septoplasty (to fix a deviated nasal septum) had the highest waiting times across all of the measures: median waiting time was 330 days, 90th percentile waiting time was 500 days and 36% of patients waited more than 365 days for surgery.

Changes over time

Between 2016–17 and 2020–21, for the 15 indicator procedures:

• Coronary artery bypass graft surgery consistently had the lowest waiting times across all of the waiting time measures. In 2020–21, the median waiting time was 18 days, the 90th percentile waiting time was 82 days and the proportion of patients who waited more than 365 days for surgery was 0.1%.
• Septoplasty had the highest median waiting times across all of these years, although between 2016–17 and 2019–20, Myringoplasty/Tympanoplasty had higher waiting times at the 90^th percentile and in terms of the proportion of patients waiting more than 365 days for surgery.

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.

Length of stay is the number of days between admission to hospital, and separation. The Average Length of Stay (ALOS) is calculated as the total number of patient days reported for the hospital (or group of hospitals), divided by the number of hospitalisations. 

OECD indicator: Length of stay

The Organisation for Economic Co-operation and Development (OECD) presents comparative information on the ALOS for overnight hospitalisations as an indicator of efficiency. The comparability of international ALOS may be affected by differences in definitions of hospitals, collection periods and admission practices.

Performance indicator: Average length of stay for selected AR-DRGs

The ALOS for selected AR-DRGs is an indicator of Efficiency and sustainability under the Australian Health Performance Framework (AHPF).

Explore the data

In the data visualisation below, you can view the ALOS by selected medical procedures, by state and territory, and by type of hospital (peer group).

Highlights

In 2020–21:

• the ALOS for overnight hospitalisations in Australia was 5.4 days, which was lower than the OECD average length of stay of 7.2 days
• there were notable differences (more than 1 day) in the ALOS between public and private hospitals for 6 of the 20 selected AR-DRGs. For example, the ALOS for Chronic obstructive airways disease, minor complexity was 2.8 days for public hospitals and 5.9 days for private hospitals.

Between 2016–17 and 2020–21:

• the overall ALOS for public and private hospitals combined decreased by an average of 1.8% per year from 2.8 days to 2.6 days
• for overnight hospitalisations, the ALOS in all hospitals combined was relatively stable between 2016–17 and 2020–21, decreasing by an average of 0.9% each year over this period.

Significant changes in ALOS over time may be related to changes in admission practices and improvements in the coverage of reporting.