Hospital activity

How is hospital activity measured?

In this report, hospital activity is measured by the number of:

  • hospitalisations in public and private hospitals
  • presentations to public hospital emergency departments
  • non-admitted patient services provided in public hospital outpatient clinics.

What type of care do patients receive?

The broad types of admitted patient care (hospitalisation) are medical care, care involving an intervention or procedure such as surgery, and other acute care, along with childbirth, mental health care and sub-acute and non-acute care such as palliative care and rehabilitation. Most hospitalisations are for acute medical care. In addition, many hospitalisations, particularly same–day hospitalisations, are for procedures, investigations, or other health management. Admitted patient care services can be provided by both public and private hospitals (Table 2).

Non-admitted patient care includes care provided in emergency departments and care provided in outpatient clinics. Care provided in outpatient clinics includes consultations with specialist medical practitioners, the provision of diagnostic or other procedures, and allied health or clinical nurse specialist services. Public hospitals provide most non-admitted patient services.

How many hospitalisations were there?

Admission to hospital is an administrative process that follows a medical officer’s decision that a patient needs to be admitted for appropriate management or treatment of their condition, and/or for appropriate care or assessment of their needs. Patients may be admitted and discharged on the same day or may stay in hospital for one or more nights.

In 2020–21, there were 11.8 million hospitalisations (418 per 1,000 population), with public and private hospitals providing 7.0 million (248 per 1,000 population) and 4.9 million hospitalisations (169 per 1,000 population) respectively.

Since 2016–17, hospitalisations have increased from 10.9 million (6.5 million in public hospitals and 4.4 million in private hospitals) but the rate of hospitalisations per 1,000 population decreased in public hospitals over the same period from 252 per 1,000 population in 2016–17.

Collectively, hospitals provided 31.2 million days of patient care in 2020–21. This was an increase since 2016–17 when 30.9 million days of patient care were provided.

Table 2: Characteristics of admitted patient care, public and private hospitals, 2020–21

 

Public hospitals

Private hospitals

All hospitals

Hospitalisations

7.0 million

4.9 million

11.8 million

Medical

4.8 million

1.5 million

6.3 million

General intervention (Surgical)

1.1 million

1.7 million

2.8 million

Specific intervention (Other)

500,000

1.0 million

1.5 million

Childbirth

235,000

66,000

301,000

Mental health care

143,000

232,000

375,000

Sub-acute and non-acute care

196,000

368,000

564,000

Overnight versus same day

55% same-day stays

73% same-day stays

63% same-day stays

Number of days of patient care

20.9 million (average decrease of 0.2% per year since 2016–17)

10.3 million (average increase of 1.0% per year since 2016–17)

31.2 million (average annual increase of 0.2% since 2016–17)

Average length of stay (for overnight stays)

5.5 days

5.1 days

5.4 days

Why do people go to hospital?

People experience different health issues at different times of their lives, so the reasons for hospitalisation vary by age and by sex. For example, in 2020–21:

  • Babies and children under 5 were hospitalised most often for ’other factors influencing health status’ (this includes examinations, investigations, observation, evaluation and other health management), whereas boys aged 5–14 were most often hospitalised for diagnoses related to injury and poisoning and girls were most often hospitalised for digestive system diseases.
  • Males aged 15–24 were also most often hospitalised for diagnoses related to ‘injury and poisoning’, however, females in this age group were most often hospitalised for diagnoses related to ‘pregnancy, childbirth and the puerperium’.
  • Adults aged 45 and over were most often hospitalised for ‘other factors influencing health status’.

The table ranks the top 3 reasons for hospitalisation in 2019–20 by sex and age-group using the ICD-10-AM chapter. The top reason for hospitalisation for both males and females in the age-groups of under 5, 45 to 64 and 65+ was for ‘Other factors influencing health status’. ‘Injury and poisoning’ were the top reason for hospitalisation for males in the age groups 5 to 14 and 15 to 24. ‘Pregnancy, childbirth, and the puerperium’ were the top reason for hospitalisation for females in the age-groups 15 to 24 and 25 to 44.

How much care do our emergency departments provide?

In Australia, there are 291 public hospitals that have purpose-built emergency departments that are staffed 24 hours a day and provide care to patients who require urgent medical, surgical or other attention.

Emergency department activity is measured by the number of presentations. In 2020–21, there were 8.8 million presentations to emergency departments – 342.5 presentations per 1,000 population. This has increased from 316.5 presentations per 1,000 population in 2016–17 – an increase of 2.0% a year.

In 2020–21, 72% of presentations occurred between 8am and 8pm. The busiest days for emergency department visits were Sundays and Mondays.

How urgent was the care?

When a patient presents to the emergency department, they are assigned a triage category by a registered nurse or medical practitioner. The triage category allocated reflects the urgency of the patient’s need for medical and nursing care (Table 3).

Table 3: Emergency department presentations by triage category, 2020–21

 

Resuscitation (should be seen immediately)

Emergency (within 10 minutes)

Urgent (within 30 minutes)

Semi-urgent (within 60 minutes)

Non-urgent (within 2 hours)

Total

Presentations

68,811

1,256,584

3,297,859

3,293,576

888,635

8,808,357

Proportion of all presentation (%)

1%

14%

37%

37%

10%

100%

In 2020–21, 26% of patients arrived at the emergency department by ambulance or air rescue service, with the remaining 74% arriving by other forms of transport, including by private car.

Why do people present to emergency departments?

A patient’s diagnosis is established at the end of the patient’s emergency department stay and identifies the main reason for their visit to the emergency department.

In 2020–21, the most common reasons for presentation at an emergency department were for 'injury, poisoning and certain other consequences of external causes' and 'symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified' – both accounting for 24% of presentations. ‘Symptoms, signs and abnormal findings’ are symptoms such as abnormalities of heartbeat, abnormalities of breathing, chest pain, nausea and vomiting, headache, and convulsions that are not attributable to a specific diagnosis based on the information available at the time of the care.

The most common diagnoses recorded for emergency department presentations vary by the age and sex of the patient.

For females under 15 years, the most common reason for presentation at an emergency department was ‘injury and poisoning’. For females over 15, the most common reason was ‘symptoms, signs and abnormal findings’. For males under 45, the most common reason was ‘injury and poisoning’. For males 45 and over, the most common reason was ‘symptoms, signs and abnormal findings’ (Figure 3).

The table ranks the top 3 reasons people present to emergency departments in 2019–20 by sex and age-group using the ICD-10-AM chapter. The top reason males and females across all age groups present to emergency department is for either ‘Injury and poisoning’ or ‘Symptoms, signs, and abnormal findings’.

How many services are provided in the outpatient setting?

In addition to care provided in emergency departments, every year many Australians receive services via ‘outpatient’ or non-admitted patient clinics. These services are often associated with an emergency or admitted patient episode for which diagnostic or follow-up care is required without needing the person to be admitted to hospital.

In 2020–21, 46.8 million non-admitted patient care service events were provided for public patients:

  • 20.4 million (44%) services were provided in Allied health and/or clinical nurse specialist intervention clinics – which provide services by an allied health professional or clinical nurse specialist.
  • 12.2 million (26%) services were provided in Medical consultation clinics – which provide services by a medical or nurse practitioner. There may also be input from allied health personnel and/or clinical nurse specialists.
  • 9.0 million (19%) services were in Diagnostic service clinics – which provide diagnostic services such as imaging, screening, clinical measurement and pathology.
  • 5.3 million (11%) services were in Procedural clinics – which provide minor surgical and non-surgical procedures (that do not require the patient to be admitted) by a surgeon or other medical specialist.

There were 8.7 million more service events (23%) provided in 2020-21 than were provided in 2019–20. The increase was likely due to the lifting of restrictions which were put in place to reduce the spread of COVID-19 virus more generally as well as easing of restrictions on hospital activity. In the five years between 2016–17 and 2020–21, the number of service events increased by 6.9% per year, on average.

Where do I go for more information?

Non-admitted patients