Notes on the data: Hospital admissions

Admissions by hospital type and sex, by principal diagnosis, by procedure and for potentially preventable conditions, 2020/21

Policy context: Admission to hospital is a formal process, and follows a decision made by an accredited medical practitioner at that hospital that a patient needs to be admitted for appropriate management or treatment of their condition, or for appropriate care or assessment of needs [1].

Patients are usually admitted to hospital either as an emergency or as a booked admission. Emergency admission patients are usually admitted through the Accident and Emergency Department: these are seriously injured or ill patients who need immediate treatment. Most patients receive hospital-based services as a booked (elective) admission, either as a same-day patient or an inpatient. A same-day patient comes to hospital for a test or treatment and returns home the same day. An overnight admission is recorded where a patient receives hospital treatment for a minimum of 1 night (that is, the patient is admitted to and separated from the hospital on different dates) or longer in the hospital.

The majority of people who have had an episode of care in a hospital express satisfaction with the service when they leave [2]. In 2022–23, among people aged 15 and over who used hospital services as an admitted patient, most reported that:

• hospital doctors and specialists spent enough time with them (71%), listened carefully (74%) and always showed respect (78%).
• hospital nurses spent enough time with them (74%), listened carefully (78%) and always showed respect (80%) [3].

However, admission to hospital per se carries a risk of adverse events, in addition to those related to any medical treatment undertaken. These include a risk of cross-infection, injury, or rarely, death [3].

References

1. Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2012-13. Health services series no. 54. (Cat. no. HSE 145.) Canberra: AIHW; 2014.
2. Australian Bureau of Statistics (ABS). Patient experiences in Australia: Summary of Findings, 2016-17. ABS; 2017 [cited: 2018 Nov 16]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2016-17~Main%20Features~Hospital%20admissions%20and%20emergency%20department%20visits~5
3. Australian Institute of Health and Welfare (AIHW). Hospital safety and quality. Available from: https://www.aihw.gov.au/reports-data/myhospitals/themes/hospital-safety-and-quality; accessed 7 December 2023.

Notes:

Introduction

The data presented are of the number of separations, or completions of the episode of care of a patient in hospital, where the completion can be the discharge, death or transfer of the patient, or a change in the type of care (e.g., from acute to rehabilitation). In this atlas the term ‘admission’ is used in place of the more technical ‘separation’. As these data relate to short-term episodes of care, and not to long-stay episodes, the number of admissions is similar to the number of separations in any year.

Note that the data are based on the count of all admissions. As such, repeat admissions for one person are counted as separate admissions. In addition, patients admitted to one hospital and transferred to another hospital are also counted as separate admissions. The impact of these hospital transfers is likely to result in a higher rate of admissions of people living in regional areas compared to the capital cities, as well as for certain conditions which are more likely to result in transfers.

Potentially preventable hospitalisations are admissions from a specified range of conditions where hospitalisation could have been potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). Data definitions for potentially preventable hospitalisations are in the National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2017 available through METeOR (METeOR ID: 630028).

Note that for reports and publications that results are not comparable between jurisdictions due to the variations in scope of hospitals for individual states and territories.

Impact of COVID-19 on hospitalisations in 2020/21: The Australian Institute of Health and Welfare advised that there were 11.8 million hospitalisations in Australia in 2020–21, up from 11.1 million in 2019–20, although not all states and territories experienced an increase at this level [1].

The data published in this atlas, which exclude same-day admissions for renal dialysis (published as a separate indicator), show the different rates of increase between 2019/20 and 2020/21 for hospitals in the capital cities and the rest of state and Northern Territory areas. Admission rates for females generally increased between these years by more than those for males, regardless of where those admitted lived (see the table below). Whereas rates of admission to private hospitals were higher for residents of the capital cities, the reverse was the case for those living in the Rest of States/NT areas.

Note: Data are not available for private hospitals in Queensland, Tasmania, the Northern Territory and the Australian Capital Territory and are therefore excluded from the ‘Private and ‘All’ totals in the table.

Change in hospital admissions (ASRs1), by hospital type and Section of State/NT, Australia, 2019/20 to 2020/21

¹ ‘ASR’ is the age-standardised rate

² 'All’ is the total of admissions to all hospitals (public acute plus private hospitals), excluding private hospitals in Queensland, Tasmania, the Northern Territory and the Australian Capital Territory

³ Greater Capital City Statistical Areas

The rate ratios for each State and Territory are available here.

References

1. Australian Institute of Health and Welfare (AIHW). AIHW media releases. Available from: https://www.aihw.gov.au/news-media/media-releases/2021/june/hospital-admissions-rose-as-covid-19-restrictions; accessed 7 December 2023.

Exclusions

The national data published by the Australian Institute of Health and Welfare exclude well babies (i.e., babies not admitted for acute care) who are nine days older or less, other than the second or subsequent live born infant of a multiple birth whose mother is currently an admitted patient. (For further information see Australian Institute of Health and Welfare. Admitted patient care 2016-17: Australian hospital statistics. Health services series no. 84. (Cat. no. HSE 201) Canberra: AIHW; 2018.)

Same-day admissions for dialysis for kidney disease have also been excluded from the data in this atlas for the categories of admissions for males, females and total people, and admissions by hospital sector, as they represent many repeat visits by a relatively small number of patients, who may have multiple admissions in a week: their inclusion can dramatically alter the geographic distribution of other categories of admissions (see the separate note for Same-day admissions for dialysis for kidney disease for further details); these data are presented separately. All other same-day admissions are included.

Details of data presented

Refer to separate note for Same-day admissions for dialysis for kidney disease.

Separate data are presented for acute hospitals for the following categories:

1. Admissions by hospital type and sex (excluding same-day admissions for renal dialysis - Z491 to Z492):

• Male total admissions - Public hospitals/ All hospitals
• Female total admissions - Public hospitals/ All hospitals
• Total admissions - Public/ Private/ All hospitals

Also see note re hospital type under Confidentiality of Data

2. Admissions by principal diagnosis:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters.

• Infectious and parasitic diseases (A00-B99), males/ females/ persons - Public hospitals
• Total cancers (C00-D48), males/ females/ persons - Public hospitals
• Endocrine, nutritional and metabolic diseases (E00-E90), males/females/persons - Public hospitals/All hospitals
  • Diabetes (E10 to E14.9), males/females/persons - Public hospitals
• Mental health related conditions (F00-F99), males/ females/ persons - Public hospitals
  • Mood affective disorders (F30-F39), males/females/persons - Public hospitals
• Nervous system diseases (G00-G99), males/ females/ persons - Public hospitals
• Eye and adnexa diseases (H00-H59), males/ females/ persons - Public hospitals
• Ear and mastoid process diseases (H60-H95), males/ females/ persons - Public hospitals
• Circulatory system diseases (I00-I99), males/ females/ persons - Public hospitals
  • Ischaemic heart disease (I20-I25), males/females/persons - Public hospitals
  • Heart failure (I50), males/females/persons - Public hospitals
  • Stroke (I60-I64), males/females/persons - Public hospitals
• Respiratory system diseases (J00-J99), males/ females/ persons - Public hospitals
  • Asthma (J45-J46), males/females/persons - Public hospitals
  • Chronic obstructive pulmonary disease (COPD) (J40-J44), males/females/persons - Public hospitals
• Digestive system diseases (K00-K93), males/ females/ persons - Public hospitals
• Skin and subcutaneous tissue diseases (L00-L99), males/ females/ persons - Public hospitals
• Musculoskeletal system and connective tissue diseases (M00-M99), males/ females/ persons - Public hospitals
• Genitourinary system diseases (N00-N99), males/ females/ persons - Public hospitals
  • Chronic kidney disease (49.0, E10.2, E11.2, E13.2, E14.2, I12, I13, I15.0, I15.1, N00-N07, N08, N11, N12, N14, N15, N16, N18, N19, N25-N28, N39.1, N39.2, E85.1, D59.3, B52.0, Q60-Q63, T82.4, T86.1), males/females/persons - Public hospitals
• Certain conditions originating in the perinatal period (P00-P96), persons - Public hospitals
• Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99), males/ females/ persons - Public hospitals
• Pregnancy, childbirth and the puerperium (O00-O99), females aged 15 to 44 years - Public hospitals
• Injury, poisoning and certain other consequences of external causes (S00-T98), males/ females/ persons - Public hospitals

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters.

• Transport crash Injury (V00-V99), males/ females/ persons - Public hospitals
• Accidental poisoning (X40-X49), persons - Public hospitals
• Falls (W00-W19), males/ females/ persons - Public hospitals
• Injury due to exposure to inanimate mechanical forces (W20-W49), males/ females/ persons - Public hospitals
• Injury due to exposure to animate mechanical forces (W50-W64), males/ females/ persons - Public hospitals
• Intentional self-harm (X60-X84), males/ females/ persons - Public hospitals
• Assault (X85-Y09), males/ females/ persons - Public hospitals
• All diagnosis of injury or poisoning, by external cause , males/ females/ persons - Public hospitals

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM)/ Australian Classification of Health Interventions (ACHI) for all procedures except hip fracture codes that are from the International Classification of Diseases (ICD-10-AM).

• Tonsillectomy, (41789-00, 41789-01, 41787-01 and/or 41786-01) - Public/ Private/ All hospitals
• Myringotomy, children aged 0 to 9 years (41632-02 (Insertion of myringotomy tube, unilateral), 41632-03 (Insertion of myringotomy tube, bilateral), 41626-00 (Myringotomy, unilateral) and/or 41626-01 (Myringotomy, bilateral)) - Public/ Private/ All hospitals
• Hysterectomy, females aged 30 to 59 years (block 1268 or 1269 or a reported procedure code of 90450-00, 90450-01 and/or 90450-02) - Public/ Private/ All hospitals
• Caesarean section, females aged 15 to 44 years (1340) - Public/ Private/ All hospitals
• Hip fracture (M84.45, S72.01, S72.02, S72.04, S72.05, S72.08, S72.03, S72.10, S72.11, S72.2 or S72.00 ) - Public/ Private/ All hospitals
• Fibre optic colonoscopy (block 905 (32090-00, 32084-00, 32084-02 and/or 32090-02)) - Public/ Private/ All hospitals
• Fibre optic colonoscopy with excision (block 911 (32090-01, 32093-00, 32087-00 and/or 32084-01)) - Public/ Private/ All hospitals

All potentially preventable hospitalisations - Vaccine-preventable, Acute and Chronic conditions

• Potentially preventable conditions by broad age groups- Public hospitals
• Potentially preventable conditions - Public hospitals

Potentially preventable hospitalisations - Vaccine-preventable

• Vaccine preventable conditions - pneumonia and influenza - Public hospitals
• Total vaccine preventable conditions - Public hospitals

Potentially preventable hospitalisations - Acute conditions

• Acute cellulitis - Public hospitals
• Acute convulsions and epilepsy - Public hospitals
• Acute dental conditions - Public hospitals
• Acute ear, nose and throat infections - Public hospitals
• Acute gangrene - Public hospitals
• Acute urinary tract infections, including pyelonephritis - Public hospitals
• Total acute conditions - Public hospitals

Potentially preventable hospitalisations - Chronic conditions

• Chronic angina - Public hospitals
• Chronic asthma - Public hospitals
• Chronic congestive cardiac failure - Public hospitals
• Chronic COPD - Public hospitals
• Chronic diabetes complications - Public hospitals
• Chronic hypertension - Public hospitals
• Chronic iron deficiency anaemia - Public hospitals
• Total chronic conditions - Public hospitals

Confidentiality of data

Counts of less than five admissions have been suppressed.

Data were not provided to PHIDU by hospital type (i.e., separate data for public hospitals and private hospitals) in Queensland, Tasmania, the Northern Territory or the Australian Capital Territory. As a result, where data are published for 'public' and 'all hospitals' for other jurisdictions, only the ‘public hospitals’ data are available for these jurisdictions. The ‘all hospitals’ data in other jurisdictions have been confidentialised where publication of public and all hospitals data would allow identification of private hospital data due to small cell sizes. The decision was made to confidentialise the ‘all hospitals’ rather than the ‘public hospitals’ figures as admissions to public hospitals, which comprise the majority of admissions, both overall and from the most disadvantaged areas, were considered to be the most relevant in the context of this atlas.

The Population Health Areas of 30057 Brisbane Inner - North - Central and 30051 Fortitude Valley/Spring Hill have been combined at the request of Queensland Health; data displayed is the combination of values and rates for these areas.

Geography: Data available by Population Health Area, Local Government Area, Primary Health Network, Quintile of socioeconomic disadvantage of area and Quintiles within PHNs, and Remoteness Area

Numerator: Admissions for the above categories

Denominator:

Admissions by hospital type and sex (excluding same-day admissions for renal dialysis): Total population, or total males/ females, where appropriate

Admissions by principal diagnosis: For pregnancy, childbirth and the puerperium, denominator is the number of females aged 15 to 44 years; for certain conditions originating in the perinatal period, the denominator is the number of live births; for all other admissions, the denominator is the total population

Admissions by principal diagnosis of injury or poisoning, by external cause: The denominator is the total population.

Admissions by procedure: For myringotomy, is children aged 0 to 9 years; for Hysterectomy, is females aged 30 to 59 years; for Caesarean section, is women aged 15 to 44 in hospital to give birth; for birth with an outcome of delivery, is women aged 15 to 44 years; and for all other admissions the denominator is the total population

Admissions for potentially preventable conditions: The denominator is the total population.

Detail of analysis: Indirectly age-standardised rate per 100,000 (respective population); and/or indirectly age-standardised ratio, based on the Australian standard.

Note the following indicators are expressed as a rate per 100 live births;

• Admissions for certain conditions originating in the perinatal period, Persons - Public hospitals, All hospitals
• Admissions for a Caesarean section, females aged 15 to 44 years - Public hospitals, All hospitals

Source: Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2020/21; and the ABS Estimated Resident Population, 30 June 2020 and 30 June 2021.

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