Report on Government Services 2016

Chapter 11, Volume E

Public hospitals

The Public hospitals chapter (chapter 11) reports on the performance of governments in providing public hospitals, with a focus on acute care services. It also reports separately on a significant component of the services provided by public hospitals - maternity services.

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Key Facts
Indicator Framework
Indicator Results
Indigenous Data

This chapter reports on the performance of governments in providing public hospitals, with a focus on acute care services including maternity services.

Public hospitals

Total recurrent expenditure on public hospitals (excluding depreciation) was $44.4 billion in 2013-14. In 2013-14, government real recurrent expenditure on public hospitals was $1905 per person for Australia, up from $1692 in 2009-10 (in 2013-14 dollars).

Funding for public hospitals comes from a number of sources. The Australian, State and Territory governments contributed 91.0 per cent of funding for public hospital services in 2013 14, with non-government sources contributing 9.0 per cent.

Non-government sources include health insurance funds, individuals, workers' compensation and compulsory third-party motor vehicle insurers.

In 2013-14, Australia had 747 public hospitals. Although 72 per cent of hospitals had 50 or fewer beds, these smaller hospitals represented only 15 per cent of total available beds.

There were approximately 5.7 million separations from public (non-psychiatric) hospitals in 2013-14. Nationally, this translates into 234.0 separations per 1000 people. Acute separations accounted for 95.3 per cent of separations from public hospitals. Of the total number of separations in public (non-psychiatric) hospitals, 51.4 per cent were for same day patients.

A total of 46.5 million individual occasions of service were provided to non-admitted patients in public acute hospitals in 2013-14.

Public hospitals services aim to provide acute and specialist services that are:

safe and of high quality
appropriate and responsive to individual needs
affordable, timely and accessible
equitably and efficiently delivered.

Maternity services

Maternity services accounted for 8.3 per cent of total acute separations in public hospitals and 10.6 per cent of the total cost of all acute separations in public hospitals in 2013-14.

In Australian public hospitals in 2013-14, vaginal deliveries accounted for a substantial proportion of the separations for pregnancy, childbirth and the puerperium (41.1 per cent). The cost of vaginal deliveries was $780.5 million in 2013-14.

Maternity services aim to provide acute and specialist services that are:

safe and of high quality
appropriate and responsive to individual needs
affordable, timely and accessible
equitably and efficiently delivered.

In this tab

Public hospitals
Maternity services

Public hospitals

The performance indicator framework provides information on equity, efficiency and effectiveness, and distinguishes the outputs and outcomes of public hospitals. The performance indicator framework shows which data are complete and comparable in the 2016 Report.

Maternity services

The performance indicator framework provides information on equity, efficiency and effectiveness, and distinguishes the outputs and outcomes of maternity services. The performance indicator framework shows which data are complete and comparable in the 2016 Report.

In this tab

Public hospitals
Maternity services

Public hospitals

An overview of the Public hospitals performance indicator results are presented. Information to assist the interpretation of these data can be found in the indicator interpretation boxes in the Public hospitals chapter and attachment tables.

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Effectiveness — Access indicators

Emergency department waiting times

Emergency department waiting times by triage category — proportion of patients seen on time (per cent), 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
Triage category	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Resuscitation	100	100	99	100	100	100	100	100	100
Emergency	82	80	77	83	69	83	78	62	79
Urgent	76	73	64	57	57	64	48	54	68
Semi-urgent	81	73	74	69	69	67	53	59	74
Non-urgent	95	89	93	93	89	89	86	88	92
Total	81	75	71	68	66	70	59	60	74

Source: Attachment table 11A.14

Length of stay for emergency department care, proportion of patients staying for four hours or less, 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	74.9	69.9	76.7	78.7	63.8	66.6	63.1	62.1	73.2

Source: Attachment table 11A.19

Emergency department waiting time to commencement of clinical care (minutes), 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
50th percentile	15	19	20	25	20	25	37	31	18
90th percentile	78	97	93	99	113	107	147	130	93

Source: Attachment table 11A.20

Waiting times for admitted patient services

Overall elective surgery waiting times, 2014-15 (days waited)

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
50th percentile	54	29	27	29	37	55	45	32	35
90th percentile	330	177	147	148	210	424	245	217	253

Source: Attachment table 11A.21

Presentations to emergency departments with a length of stay of 4 hours or less ending in admission, public hospitals (per cent), 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
Triage category	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Resuscitation	51	56	59	68	54	58	57	46	56
Emergency	43	49	56	60	37	35	46	24	48
Urgent	40	48	56	52	34	26	31	21	45
Semi-urgent	45	51	60	53	40	28	35	22	48
Non-urgent	65	64	66	63	58	45	42	29	63
Total	43	49	57	55	37	29	36	23	47

Source: Attachment table 11A.44

Length of stay of emergency department presentations ending in admission — Time waited at 50th percentile by triage category (hours:minutes), 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Resuscitation	3:59	3:45	3:37	3:04	3:36	3:24	3:27	4:28	3:45
Emergency	4:39	4:03	3:49	3:38	5:11	5:28	4:24	7:17	4:11
Urgent	4:58	4:14	3:52	3:58	5:31	6:24	5:51	7:22	4:26
Semi-urgent	4:32	3:59	3:44	3:56	4:52	6:12	5:22	6:54	4:11
Non-urgent	3:18	3:24	3:20	3:37	3:12	4:25	4:36	6:32	3:26
Total	4:43	4:05	3:50	3:53	5:12	6:05	5:21	7:08	4:16

Source: Attachment table 11A.45

Effectiveness — Appropriateness indicators

Separation rates for selected procedures

Separation rates for selected procedures in public hospitals, per 1000 people (age standardised), 2013-14

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Cataract extraction	8.3	8.7	9.6	10.6	8.0	10.4	7.4	9.1	8.9
Cholecystectomy	2.2	2.3	2.4	2.0	2.1	2.4	2.5	1.7	2.2
Coronary angioplasty	1.5	1.5	1.5	1.4	1.2	1.2	3.2	0.3	1.5
Coronary artery bypass graft	0.5	0.5	0.6	0.4	0.6	0.3	0.7	..	0.5
Cystoscopy	3.9	6.1	5.5	7.8	6.0	4.8	5.8	3.1	5.4
Haemorrhoidectomy	2.7	1.8	1.5	1.2	1.5	1.9	1.0	1.9	1.9
Hip replacement	1.4	1.7	1.4	1.7	1.7	1.9	2.3	0.7	1.6
Hysterectomy	2.1	2.3	2.7	3.8	1.8	2.7	3.8	0.8	2.4
Inguinal herniorrhaphy	2.0	2.1	2.1	2.1	2.0	2.1	2.4	1.7	2.1
Knee replacement	1.9	1.7	2.0	2.2	2.1	1.6	2.4	0.8	1.9
Myringotomy	1.4	1.7	1.4	2.0	2.6	1.2	2.3	0.7	1.6
Prostatectomy	2.5	2.8	2.7	2.9	1.9	2.6	8.1	0.2	2.6
Septoplasty	1.2	1.3	0.9	1.0	1.4	0.5	1.2	0.5	1.1
Tonsillectomy	2.3	2.6	2.3	2.8	2.8	1.8	4.0	1.2	2.5
Varicose veins, stripping and ligation	0.6	0.7	0.5	0.6	0.6	0.4	1.0	0.5	0.6

Source: Attachment table 11A.46

Effectiveness — Quality — Safety indicators

Selected unplanned hospital readmission rates

Rate at which patients unexpectedly return to hospital within 28 days for further treatment of the same condition (per 1000 separations), 2013-14

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
Surgical procedure prior to separation	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Knee replacement	21.4	21.2	31.3	34.4	18.5	33.8	30.6	np	23.7
Hip replacement	18.1	16.3	19.3	24.8	20.9	14.9	18.4	–	17.8
Tonsillectomy and adenoidectomy	28.5	30.1	43.4	45.4	35.7	35.3	27.3	58.5	33.0
Hysterectomy	28.6	26.0	34.8	37.3	30.9	8.4	64.1	np	29.8
Prostatectomy	25.8	19.8	30.4	29.6	29.3	30.5	np	np	25.5
Cataract surgery	2.7	3.7	4.3	2.1	1.7	2.1	–	9.3	3.1
Appendicectomy	18.3	20.3	19.7	32.9	25.7	19.1	30.2	34.9	20.3

Source: Attachment table 11A.47

Accreditation

Selected healthcare-associated infections in acute care hospitals, per 10 000 patient days, 2014-15

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	92.9	100.0	91.1	100.0	98.8	17.4	100.0	100.0	93.2

Source: Attachment table 11A.49

Adverse events in public hospitals

Selected healthcare-associated infections in acute care hospitals, per 10 000 patient days, 2014-15

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
rate	0.8	0.7	0.8	0.8	0.8	0.8	0.8	0.7	0.8

Source: Attachment table 11A.50

Adverse events treated in hospitals, per 100 separations, 2013-14

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Rate	6.4	7.0	6.4	7.0	7.3	8.4	7.3	3.7	6.7

Source: Attachment table 11A.51

Falls resulting in patient harm in public hospitals, per 1000 separations, 2013-14

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Rate	5.1	3.4	3.4	4.5	4.9	6.5	3.8	1.8	4.2

Source: Attachment table 11A.52

Efficiency sustainability indicators

Workforce sustainability

Nursing workforce by age group (per cent), 2014

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
<30	15.8	18.0	15.3	16.4	14.5	13.1	16.7	17.2	16.2
30-39	20.2	20.9	20.7	20.8	19.3	15.9	22.3	26.6	20.5
40-49	23.5	24.7	26.7	25.3	25.2	25.5	25.2	22.8	24.9
50-59	28.3	25.6	26.8	26.5	30.4	33.9	25.7	23.8	27.3
60+	12.3	10.7	10.4	11.0	10.7	11.6	10.1	9.7	11.1

Source: Attachment table 11A.54

Medical practitioner workforce by age group (per cent), 2014

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
<30	9.1	10.6	9.8	10.4	9.8	9.7	9.8	10.6	9.8
30-39	26.2	28.5	28.5	29.2	27.6	24.5	26.8	37.3	27.8
40-49	24.3	23.4	25.8	25.7	24.5	25.8	24.4	22.2	24.5
50-59	20.8	20.6	20.9	19.5	20.5	22.5	23.1	16.8	20.7
60+	19.5	16.9	15.0	15.2	17.6	17.5	15.8	13.1	17.2

Source: Attachment table 11A.56

Efficiency indicators

Cost per casemix adjusted separation

Recurrent cost per casemix-adjusted separation, 2013-14

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$	4788	4228	4783	5624	5402	4942	6664	6840	4836

Source: Attachment table 11A.57

Total cost per casemix-adjusted separation, 2013-14

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$	738	819	614	554	710	668	907	548	709

Source: Attachment table 11A.58

Relative stay index, 2013-14

Acute care patient days divided by expected number of acute care patient days, adjusted for casemix

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Total	1.03	0.92	0.86	0.97	1.05	0.99	1.08	1.14	0.97

Source: Attachment table 11A.59

Recurrent cost per non-admitted occasion of service, 2013-14

Most recent data for this measure are neither comparable nor complete (chapter 11) Data are available in attachment tables 11A.61-11A.65

Outcome indicators

Patient satisfaction, 2014-15

Proportion (%) of persons who went to an emergency department in the last 12 months reporting that:

ED doctors, specialists or nurses always or often listened carefully to them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	86.9	83.7	83.9	88.8	84.4	87.4	86.8	85.5	85.2
Nurses	90.5	91.2	88.6	92.6	88.2	91.2	91.8	91.2	90.4

ED doctors, specialists or nurses always or often showed respect to them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	90.1	86.1	86.6	89.5	86.4	88.1	89.3	88.2	87.7
Nurses	90.8	90.3	88.7	92.7	88.6	93.7	94.8	91.2	90.7

ED doctors, specialists or nurses always or often spent enough time with them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	85.0	80.9	81.2	83.7	80.4	82.5	82.0	87.1	82.4
Nurses	87.6	85.9	84.4	90.7	85.1	88.5	89.4	91.5	86.8

Proportion (%) of persons who were admitted to hospital in the last 12 months reporting that:

Hospital doctors, specialists or nurses always or often listened carefully to them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	92.0	88.8	88.8	88.9	89.1	88.8	88.1	94.3	89.9
Nurses	92.9	89.6	90.0	90.7	89.9	91.8	91.6	94.7	90.8

Hospital doctors, specialists or nurses always or often showed respect to them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	92.5	90.7	90.2	90.5	91.1	90.1	88.5	90.5	91.0
Nurses	93.7	91.1	90.3	90.7	90.3	92.7	90.1	94.7	91.9

Hospital doctors, specialists or nurses always or often spent enough time with them

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Doctors / specialists	89.6	84.9	86.4	87.0	88.2	84.5	83.3	90.2	87.2
Nurses	90.0	88.6	87.7	85.9	86.4	90.3	88.4	93.1	88.6

Source: Attachment tables 11A.69-76

Sentinel events, 2012-13

Adverse events occurring due to hospital system and process deficiencies that result in death of, or serious harm to, a patient

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11) Data are available in tables 11A.77-11A.85

Maternity services

An overview of the Maternity services performance indicator results are presented. Information to assist the interpretation of these data can be found in the indicator interpretation boxes in the Public hospitals chapter and attachment tables.

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Effectiveness — Appropriateness indicators

Caesareans and inductions for selected primiparae

Proportion (%) of births for selected primiparae that were caesareans / inductions, public hospitals, 2014

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Caesareans	23.5	25.1	22.6	25.0	28.4	24.1	22.4	29.7	24.3
Inductions	40.4	38.6	31.1	37.6	41.0	50.1	30.4	41.7	37.9

Source: Attachment table 11A.90

Instrumental vaginal births

Proportion of births for women giving birth for the first time that were instrumental vaginal births, 2013

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	22.9	29.1	22.4	29.6	24.2	23.0	28.4	19.4	25.3

Source: Attachment table 11A.99

Vaginal birth after caesarean section, 2013

Proportion (%) of multiparous mothers who have had a previous caesarean, whose current method of birth was either an instrumental or non-instrumental vaginal birth, 2013

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Non-instrumental	12.5	10.2	12.8	9.7	12.7	13.2	14.1	19.1	11.8
Instrumental	3.7	4.1	2.7	3.6	3.5	3.1	5.5	3.4	3.6

Source: Attachment table 11A.100

Effectiveness — Quality — Safety indicators

Perineal status after vaginal birth

Proportion of women with third or fourth degree lacerations to the perineum following vaginal birth, 2013

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
%	2.0	1.9	2.2	1.6	2.3	1.8	4.4	2.0	2.0

Source: Attachment table 11A.101

Efficiency indicators

Recurrent cost per maternity separation

Recurrent cost per maternity separation without catastrophic or severe complications and comorbidities (dollars), public hospitals, 2013-14.

Most recent data for this measure are not comparable but are complete (subject to caveats) (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
$/Caesarean	8279	10 241	9874	8803	13 458	9921	15 932	11 425	9811
$/Vaginal delivery	5930	6512	6167	5315	8291	5655	12 703	6214	6423

Source: Attachment table 11A.102

Mother's average length of stay

Average length of stay for selected maternity AR-DGs, public hospitals (days), 2013-14

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
O01C Caesarean delivery	3.6	3.5	3.2	3.5	3.7	3.6	3.5	4.2	3.5
O60C Vaginal delivery	2.3	2.2	1.9	2.2	2.1	2.3	1.8	2.8	2.2

Source: Attachment table 11A.103

Outcome indicators

Baby's Apgar score at 5 minutes

Proportion of live births with an Apgar score of less than 4, at 5 minutes, by birthweight category, 2014

Most recent data for this indicator are neither comparable nor complete (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
<1500g	14.5	18.2	18.2	5.8	9.0	18.8	13.2	25.5	15.1
1500-1999g	0.8	0.7	1.4	0.3	–	–	2.1	1.7	0.9
2000-2499g	0.4	0.3	0.6	0.5	0.3	0.5	0.4	0.5	0.4
2500g+	0.2	0.2	0.2	0.2	0.1	0.1	0.5	0.3	0.2

Source: Attachment table 11A.104

Perinatal death rate

Perineal death rate per 1000 total births, 2013

Most recent data for this measure are comparable and complete, subject to caveats (chapter 11)
	NSW	Vic	Qld	WA	SA	Tas	ACT	NT	Aust
Fetal deaths	5.6	6.0	5.9	5.9	3.8	7.2	5.2	9.5	5.7
Neonatal deaths	2.6	2.1	3.2	1.6	2.3	2.3	1.8	4.9	2.5
Perinatal deaths	8.1	8.2	9.1	7.5	6.1	9.5	7.0	14.4	8.2

Source: Attachment tables 11A.105-108

Legend

– Nil or rounded to zero.

.. Not applicable.

np Not published.

Performance indicator data for Aboriginal and Torres Strait Islander people in this chapter are available in the attachment tables listed below. Contextual data and further supporting information can be found in the chapter.

Indigenous public hospitals data
Table number	Table title
Table 11A.16	Patients treated within national benchmarks for emergency department waiting time, by Indigenous status, by State and Territory
Table 11A.23	Waiting times for elective surgery in public hospitals, by Indigenous status and procedure, by State and Territory (days)
Table 11A.48	Selected unplanned hospital readmission rates, by Indigenous status, hospital peer group, remoteness and SEIFA IRSD quintiles, 2013-14
Table 11A.52	Separations for falls resulting in patient harm in hospitals, per 1000 separations, 2013-14
Table 11A.109	Perinatal, neonatal and fetal deaths