Summary

The length of time patients spend in hospital for specific conditions has a large impact on overall health system costs. Although longer hospital stays can be due to factors outside a hospital’s control, it is also likely there are considerable opportunities to increase efficiency by reducing longer hospital stays, provided patients are not put at risk by being sent home too soon.

This report provides information on length of stay among patients who spent at least one night in a public hospital for one of 16 selected conditions and procedures. It compares average lengths of stay in Australia’s 125 largest public hospitals against their peers, based on hospital size and location, for each of these conditions or procedures. All of the 16 are common and together they represent major areas of medical and surgical care. 

Information about the average length of stay among patients offers some insight into the efficiency of hospitals and local health systems in the following ways:

  • A shorter stay is more efficient from a hospital’s perspective, making beds available more quickly to provide care for more patients, as well as reducing the cost per patient. However, stays that are too short may reduce the quality of care and result in poorer patient outcomes.
  • Longer stays are often due to complications and may be associated with a higher risk of adverse events.
  • Longer stays may also be due to factors unrelated to the patient’s clinical condition, such as delays in consulting or coordinating care with other health professionals who have a role in assisting the patient’s recovery. Longer stays can also occur if there are delays in ensuring the patient is accepted into another service, such as a rehabilitation facility, aged care home or community care service.

 The Council of Australian Governments (COAG), which approved the 48 indicators on which the Authority bases its work, included length of stay in hospital as one of the measures to be used to assess hospital efficiency. Length of stay is a useful measure because it means that among hospitals that are keeping patients in hospital longer than average, resources are being taken up that other hospitals with shorter lengths of stay can use for other patients.

The Authority has taken a number of steps to ensure comparisons are between similar patients as well as similar hospitals. The report is the first in a series of reports by the Authority assessing efficiency and effectiveness of local health systems. It is accompanied by a companion report that examines variations in the number of potentially avoidable hospitalisations in local communities across the nation. Because one patient may need to occupy a hospital bed for one day or for many days, this report quantifies hospital use in terms of ‘bed days’ (Figure 1, page ix).

In 2011–12, there were more than 5.7 million stays in public hospitals across Australia. These patients used a total of 19.1 million hospital bed days. Of these, 2.9 million stays lasted one or more nights, accounting for 16.3 million bed days. In 2011–12, there were 382,006 stays of one or more nights in public hospitals for the 16 conditions and procedures presented in this report. This represents 7.7% of all bed days in public hospitals. These patients used a total of 1.48 million hospital bed days.

Key findings

For each of the 16 conditions or procedures analysed in the report, the Authority found variation in the length of time similar patients spent in hospital, even among hospitals of similar size and rurality. The specific breakdown for each condition and procedure is below.

Childbirth

Childbirth is one of the most common reasons for admission to hospital.

Vaginal delivery

In 2011–12, there were 99,674 vaginal deliveries in public hospitals. On average these women spent 2.5 days in hospital, accounting for 253,367 bed days nationally. There was variation between similar hospitals in the average length of stay (Figure 5, page 11).  At major metropolitan hospitals, which account for 57% of the bed days for vaginal deliveries in public hospitals, the average length of stay was 60% longer at some hospitals compared to others (range from 2.0 to 3.1 days).

Caesarean delivery

In 2011–12, there were 45,405 caesarean deliveries, accounting for 31% of all births in public hospitals. Across Australia, the caesarean rate has increased rapidly in recent years and is now higher than in most other comparable nations. On average women who had a caesarean delivery spent 50% longer in hospital (an average of 3.8 days) than women who had a vaginal delivery, accounting for 172,834 bed days nationally. There was variation between similar hospitals in the average length of stay.

At major metropolitan hospitals, which account for 57% of the bed days for caesarean deliveries in public hospitals, the average length of stay was 60% longer at some hospitals compared to others (range from 3.0 to 4.7 days) (Figure 5, page 11).

Medical conditions

The report looks at four common medical conditions. For three of these conditions, lung disease (COPD), heart failure, and kidney and urinary tract infections, the Authority assesses the impact of complications or comorbidities.

Cellulitis

In 2011–12, there were 39,308 stays in public hospitals for cellulitis. On average these patients spent 3.8 days in hospital, accounting for 149,355 bed days nationally. There was variation between similar hospitals in the average length of stay (Figure 7, page 15). At major metropolitan hospitals, which account for 39% of the bed days for cellulitis cases in public hospitals, the average length of stay was more than twice as long at some hospitals compared to others (range from 2.1 to 5.5 days).

Chronic obstructive pulmonary disease (COPD) without complications

In 2011–12, there were 36,590 stays in public hospitals for COPD without complications. On average these patients spent 5.0 days in hospital, accounting for 183,567 bed days nationally. There was variation between similar hospitals in the average length of stay (Figure 9, page 17). At major metropolitan hospitals, which account for 39% of the bed days for COPD cases without complications in public hospitals, the average length of stay was 80% longer at some hospitals compared to others (range from 3.5 to 6.3 days).

COPD with complications

People with COPD were considered to be a complex admission or had a complication 25% of the time. On average these people spent 69% longer in hospital, or 8.5 days in hospital, accounting for 80,610 bed days nationally (Figure 9, page 17).

Heart failure without complications

In 2011–12, there were 20,518 stays in public hospitals for heart failure without complications. On average these patients spent 5.1 days in hospital, accounting for 105,526 bed days nationally. There was variation between similar hospitals in the average length of stay (Figure 11, page 19). At major metropolitan hospitals, which account for 45% of the bed days for heart failure cases without complications in public hospitals, the average length of stay was twice as long at some hospitals compared to others (range from 3.2 to 6.7 days).

Heart failure with complications

People with heart failure were considered to be a complex admission or had a complication 35% of the time. On average these people spent twice as long in hospital, on average 9.9 days in hospital, accounting for 105,526 bed days nationally (Figure 11, page 19).

Kidney and urinary tract infections without complications

In 2011–12, there were 28,844 stays in public hospitals for kidney and urinary tract infections without complications. On average these patients spent 3.2 days in hospital, accounting for 92,108 bed days nationally. There was variation between similar hospitals in the average length of stay (Figure 13, page 21). At major metropolitan hospitals, which account for 44% of the bed days for kidney and urinary tract infection cases without complications in public hospitals, the average length of stay was nearly twice as long at some hospitals compared to others (range from 2.0 to 4.4 days).

Kidney and urinary tract infections with complications

People with kidney and urinary tract infections were considered to be a complex admission or had a complication 33% of the time. On average these people with complications spent more than twice as long in hospital (7.5 days) compared to patients without complications, accounting for 88,436 bed days nationally (Figure 13, page 21).

Surgical procedures

This report looks at seven common surgical procedures and assesses the impact of differences between similar hospitals in length of stay.

Appendix removal

In 2011–12, there were 19,817 stays for appendix removal. On average these patients spent 2.2 days in hospital. There was variation between similar hospitals in the average length of stay (Figure 15, page 25). At major metropolitan hospitals, which account for 54% of bed days for these procedures, the average length of stay was nearly twice as long at some hospitals compared to others (range from 1.6 to 3.0 days).

Gallbladder removal

In 2011–12, there were 20,959 stays for gallbladder removal. On average these patients spent 1.9 days in hospital. There was variation between similar hospitals in the average length of stay (Figure 17, page 27). At major metropolitan hospitals, which account for 54% of bed days for these procedures, the average length of stay was nearly three times longer at some hospitals compared to others (range from 1.1 to 3.2 days).

Knee replacement and hip replacement

In 2011–12, there were 10,199 stays for knee replacement and 10,549 for hip replacement. On average these patients spent 5.5 and 6.4 days in hospital, respectively. There was variation between similar hospitals in the average length of stay (Figure 25, page 33). At major metropolitan hospitals, which account for 41% of bed days for knee replacements, the average length of stay was more than twice as long at some hospitals compared to others (range from 3.3 to 8.7 days).

At major metropolitan hospitals, which account for 53% of bed days for hip replacements, the average length of stay was nearly four times longer at some hospitals compared to others (range from 3.8 to 15.0 days).

Other procedures

The number of stays and average length of stay related to hysterectomy, gynaecological reconstructive procedures and prostate removal are on pages 28 to 31 and 34 to 35.

Next steps

Hospitals are encouraged to use these results to better understand how they manage patients and how they compare to other similar hospitals across Australia. Hospitals can use these methods to investigate other conditions and procedures that are important to them to understand the impact of changing how they manage patients. The Authority will continue to engage health care providers to understand their needs with regards to comparable measures of hospital efficiency and with the public to improve their understanding how health services are supplied to the community.

Efficiency and effectiveness in Australia’s health care system

Efficiency and effectiveness are important factors to consider in assessing health system performance. Spending resources on a particular activity means they are not available for other activities. It is important to ensure that services are directed in ways that will achieve the best possible outcomes, and that services deliver anticipated outcomes at an acceptable level.

The Performance and Accountability Framework, which contains the 48 COAG-agreed indicators that shape the Authority’s work, recognises the importance of efficiency and effectiveness by including a number of indicators for each. Relative length of stay is an efficiency indicator for hospitals and is intended to help assess how efficiently hospitals provide services. Another perspective on efficiency and effectiveness in Australia’s health system is provided in a separate report being published simultaneously by the Authority.

Figure 1: How hospital use is measured