Notes on the data: Hospital admissions

Admissions by hospital type and sex, by principal diagnosis, by procedure and for potentially preventable conditions, 2017/18

 

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]. However, admission to hospital carries with it a risk of harm. In Australia rates of serious adverse medical events are similar to those found in studies in the United States, with 0.3% of hospital admissions associated with an iatrogenic (medically caused) death and 1.7% associated with major iatrogenic disability [3]. Admission to hospital per se also 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.

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. Runciman WB, Webb RK, Helps SC et al. A comparison of iatrogenic injury studies in Australia and America II: reviewer behaviour and quality of care. The International Journal of Quality in Healthcare 2000;12(5):379-88.
 

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).

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.

All hospital admissions where addresses were unknown are included in the Australian total and are not represented by State/Territory.

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

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/ All hospitals
  • Total cancers (C00-D48), males/ females/ persons - Public/ All 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/ All hospitals
  • Mental health related conditions (F00-F99), males/ females/ persons - Public/ All hospitals
    • Mood affective disorders (F30-F39), males/females/persons - Public hospitals/ All hospitals
  • Nervous system diseases (G00-G99), males/ females/ persons - Public hospitals/ All hospitals
  • Eye and adnexa diseases (H00-H59), males/ females/ persons - Public hospitals/ All hospitals
  • Ear and mastoid process diseases (H60-H95), males/ females/ persons - Public hospitals/ All hospitals
  • Circulatory system diseases (I00-I99), males/ females/ persons - Public/ All hospitals
    • Ischaemic heart disease (I20-I25), males/females/persons - Public hospitals/ All hospitals
    • Heart failure (I50), males/females/persons - Public hospitals/ All hospitals
    • Stroke (I60-I64), males/females/persons - Public hospitals/ All hospitals
  • Respiratory system diseases (J00-J99), males/ females/ persons - Public/ All hospitals
    • Asthma (J45-J46), males/females/persons - Public hospitals/ All hospitals
    • Chronic Obstructive Pulmonary Disease (COPD) (J40-J44), males/females/persons - Public hospitals/ All hospitals
  • Digestive system diseases (K00-K93), males/ females/ persons - Public/ All hospitals
  • Skin and subcutaneous tissue diseases (L00-L99), males/ females/ persons - Public hospitals/ All hospitals
  • Musculoskeletal system and connective tissue diseases (M00-M99), males/ females/ persons - Public/ All hospitals
  • Genitourinary system diseases (N00-N99), males/ females/ persons - Public/ All 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/ All hospitals
  • Certain conditions originating in the perinatal period (P00-P96), persons - Public hospitals/ All hospitals
  • Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99), males/ females/ persons - Public hospitals/ All hospitals
  • Pregnancy, childbirth and the puerperium (O00-O99), females aged 15 to 44 years - Public/ All hospitals
  • Injury, poisoning and certain other consequences of external causes (S00-T98), males/ females/ persons - Public/ All hospitals
3. Admissions by principal diagnosis of injury or poisoning, by external cause:

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/ All hospitals
  • Accidental poisoning (X40-X49), persons - Public/ All hospitals
  • Falls (W00-W19), males/ females/ persons - Public/ All hospitals
  • Injury due to exposure to inanimate mechanical forces (W20-W49), males/ females/ persons - Public/ All hospitals
  • Injury due to exposure to animate mechanical forces (W50-W64), males/ females/ persons - Public/ All hospitals
  • Intentional self-harm (X60-X84), males/ females/ persons - Public/ All hospitals
  • Assault (X85-Y09), males/ females/ persons - Public/ All hospitals
  • Other diagnosis of injury or poisoning, by external cause (W65-W74, X00-X19, and other reported external cause codes), males/ females - Public/ All hospitals
  • Other diagnosis of injury or poisoning, by external cause (W65-W74, and other reported external cause codes), persons - Public/ All hospitals
  • All diagnosis of injury or poisoning, by external cause , males/ females/ persons - Public/ All hospitals
4. Admissions by procedure:

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, 41787-01, 41786-01, 41789-01) - Public/ Private/ All hospitals
  • Myringotomy, children aged 0 to 9 years (309) - Public/ Private/ All hospitals
  • Hysterectomy, females aged 30 to 59 years (Procedure flag–Block [1268], [1269]; Codes 90450-00 [989], 90450-01 [989] and 90450-02 [989]) - Public/ Private/ All hospitals
  • Caesarean section, females aged 15 to 44 years (1340) - Public/ Private/ All hospitals
  • Coronary artery bypass graft (672-679) - Public/ Private/ All hospitals
  • Coronary angioplasty (669-671) - Public/ Private/ All hospitals
  • Cardiac catheterisation (667-668) - Public/ Private/ All hospitals
  • Hip fracture (M84.45, S72.00-S72.05, S72.08, S72.10-S72.11, S72.2) - Public/ Private/ All hospitals
  • Knee replacement (1518-1519, 1523-1524) - Public/ Private/ All hospitals
  • Knee arthroscopy (1501, 1503, 1505, 1517) - Public/ Private/ All hospitals
  • Fibre optic colonoscopy (32090-00, 32084-00, 32084-02 and/or 32090-02) - Public/ Private/ All hospitals
  • Fibre optic colonoscopy with excision (32090-01, 32093-00, 32087-00 and/or 32084-01) - Public/ Private/ All hospitals
5. Admissions for potentially preventable conditions:

 

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

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

Potentially preventable hospitalisations - Vaccine-preventable

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

Potentially preventable hospitalisations - Acute conditions

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

Potentially preventable hospitalisations - Chronic conditions

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

Confidentiality of data

Counts of less than five admissions have been suppressed.

Data were not provided to PHIDU by sector (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.

Note: Given the above, remoteness/ quintile data for both private hospitals and all hospitals are also not published for these States and Territories or for the whole of Australia.

 

Geography: Data available by Population Health Area, Local Government Area, Primary Health Network, quintile of socioeconomic disadvantage of area and Remoteness Areas

 

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 2017/18; and the ABS Estimated Resident Population, 30 June 2017 and 30 June 2018.

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