Variation in hospital admission policies and practices

117 Pages·2017·1.33 MB·English

Variation in hospital
admission policies
and practices:
Australian hospital statistics
This report describes variations in admission policies
and practices and how these differences may be
impacting on national data on admitted patient care in
Australia’s hospitals. For the reporting period 2013–14,
hospital admission practice variation was greatest for
short-stay, same-day admissions, with data consistency
and comparability relatively good for overnight patients.
aihw.gov.au
Stronger evidence,
better decisions,
improved health and welfare
Stronger evidence,
better decisions,
improved health and welfare

HEALTH SERVICES SERIES
Number 79
Variation in hospital admission policies
and practices: Australian hospital
statistics
Australian Institute of Health and Welfare
Canberra
Cat. no. HSE 193
The Australian Institute of Health and Welfare is a major national agency whose purpose is to
create authoritative and accessible information and statistics that inform decisions and
improve the health and welfare of all Australians.
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ISSN 2205-5096 (PDF)
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Suggested citation
Australian Institute of Health and Welfare 2017. Variation in hospital admission policies and practices:
Australian hospital statistics. Health services series no. 79. Cat. no. HSE 193. Canberra: AIHW.
Australian Institute of Health and Welfare
Board Chair Director
Mrs Louise Markus Mr Barry Sandison
Any enquiries relating to copyright or comments on this publication should be directed to:
Australian Institute of Health and Welfare
GPO Box 570
Canberra ACT 2601
Tel: [phone]
Email: [email protected]
Published by the Australian Institute of Health and Welfare
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(Environmental Management Systems) and ISO 9001
(Quality Management Systems). The paper is sourced from
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Please note that there is the potential for minor revisions of data in this report.
Please check the online version at <www.aihw.gov.au> for any amendments.
Contents
Acknowledgments ................................................................................................................ v
Abbreviations ...................................................................................................................... vi
Symbols .............................................................................................................................. vii
Summary ............................................................................................................................ viii
Key messages ...............................................................................................................viii
Recommendation ..........................................................................................................viii
1 Introduction ...................................................................................................................1
1.1 Background .............................................................................................................. 1
1.2 Why is this important? .............................................................................................. 1
1.3 This report ................................................................................................................ 2
1.4 Understanding admitted care data ............................................................................ 2
1.5 Pathways to admission ............................................................................................. 4
1.6 Sources of variation .................................................................................................. 6
1.7 How variations influence performance reporting ....................................................... 6
2 Contextual factors that affect hospital admission .................................................... 12
2.1 Admission policies, legislation and data standards ................................................. 12
State and territory admission policies...................................................................... 12
Legislation and national standards .......................................................................... 12
2.2 Models of service delivery ....................................................................................... 14
2.3 Location of hospital and availability of other health services ................................... 14
2.4 Funding models ...................................................................................................... 14
3 Admission criteria in detail: points of variation ........................................................ 15
3.1 Acute care .............................................................................................................. 17
Same-day admitted care and ‘Type B’ procedures.................................................. 17
Other possible areas of variation ............................................................................ 25
3.2 Non-acute care ....................................................................................................... 25
Rehabilitation .......................................................................................................... 25
3.3 Other points of variation .......................................................................................... 29
Mental health-related care ...................................................................................... 29
Hospital-in-the-home .............................................................................................. 32
Type of care............................................................................................................ 32
Eligibility of private patients for HITH ...................................................................... 34
Additional points of variation ................................................................................... 35
Admission time ....................................................................................................... 35
iii
Certification for admitted care and clinical discretion ............................................... 36
Newborn care ......................................................................................................... 36
Care type changes and transfers ............................................................................ 39
Transfers ................................................................................................................ 41
Other issues ........................................................................................................... 41
4 The transition between non-admitted emergency care and admitted care ............. 43
4.1 Points of variation ................................................................................................... 43
Short stay admissions from the emergency department.......................................... 43
Admitted patients with episode of care in the emergency department only ............. 45
Admission date and time......................................................................................... 45
Other issues identified ............................................................................................ 47
5 Outcomes of this work ................................................................................................ 48
5.1 Measurement of the duration of admitted care ........................................................ 48
Development and collection of new data items ....................................................... 48
5.2 Other related work underway .................................................................................. 49
Appendix A: Additional material referenced in report .................................................... 50
Glossary .............................................................................................................................. 99
References ........................................................................................................................ 100
List of tables ..................................................................................................................... 103
List of figures ................................................................................................................... 105
List of boxes ..................................................................................................................... 105
Related publications ........................................................................................................ 106
iv
Acknowledgments
This report was developed as part of a broader project, funded by the Australian Health
Ministers’ Advisory Council (AHMAC), to improve the comparability of national admitted
patient data and/or reporting. The AIHW would like to acknowledge the following committees
and organisations for their contribution to this work:
• The National Health Information Standards and Statistics Committee of AHMAC
– Health authorities of the Commonwealth, states and territories
– Australian Bureau of Statistics
– Australian Commission on Safety and Quality in Health Care
– Australian Private Hospitals Association
– Department of Human Services
– Department of Veterans’ Affairs
– Independent Hospital Pricing Authority
– National Chief Health Information Officers Forum
– Australian Digital Health Agency
– National Health Funding Body
– Productivity Commission
– Private Healthcare Australia
• Day Hospitals Australia (formerly Australian Day Hospital Association)
• Australian Healthcare and Hospitals Association
• Australian Health Service Alliance
• Bupa
• Hospitals Principal Committee of AHMAC
• Mental Health Information Strategy Standing Committee of AHMAC
• Royal Australasian College of Surgeons
• The Australasian College for Emergency Medicine
The report was authored by Sally Mills, with contributions from Clara Jellie,
Jenny Hargreaves and Barbara Gray.
v
Abbreviations
ABF Activity Based Funding
ACHI Australian Classification of Health Interventions
ACT Australian Capital Territory
AHMAC Australian Health Ministers’ Advisory Council
AIHW Australian Institute of Health and Welfare
AN-SNAP Australian National Subacute and Non-acute Patient Classification
APC admitted patient care
AR-DRG Australian Refined Diagnosis Related Groups
ED emergency department
ENT ear, nose and throat
ESWT elective surgery waiting time
HITH hospital-in-the-home
ICD-10-AM International Statistical Classification of Diseases and Related Health
Problems, 10th Revision, Australian Modification
MBS Medicare Benefits Schedule
METeOR Metadata Online Registry
NAPEDC Non-admitted Patient Emergency Department Care
NHISSC National Health Information Standards and Statistics Committee
NHMD National Hospital Morbidity Database
NMDS national minimum data set
NNAPEDCD National Non-admitted Patient Emergency Department Care Database
NNAPC (agg)D National Non-admitted Patient Care (aggregate) Database
NSW New South Wales
NT Northern Territory
PAF Performance and Accountability Framework
Qld Queensland
RMHC residential mental health care
SA South Australia
SCN special care nursery
SSU short stay unit
Tas Tasmania
Vic Victoria
vi
WA Western Australia
Symbols
— nil or rounded to zero
. . not applicable
n.p. not publishable because of small numbers, confidentiality or other
concerns about the quality of the data
vii
Summary
For the last 3 decades, hospital statistics have been compiled by the Australian Institute of
Health and Welfare on a national basis. The implementation of national standards and
definitions has improved greatly the quality and comparability of hospital data over time;
however, differences in definitions and recording still exist. This report describes variation in
hospital admission policies and practices and how these differences may be impacting on
data reported. Drawing on both quantitative analysis and input from a range of stakeholders,
it is a valuable resource for data users interested in understanding more about the
comparability of Australia’s national hospital data, and how best to use and interpret the data.
Key messages
• The clinical needs of patients are paramount in determining the most appropriate
pathway for their care. Variation in admission practice can reflect variation in
administrative or funding arrangements rather than the nature of clinical care provided to
similar patients.
• For overnight-stay patients, there was limited evidence of hospital admission practice
variation, with data consistency and comparability being relatively good.
• Variation in same-day hospital admission was greater, and mostly reflected local
admission policies and practices.
• Variation in same-day acute care was particularly identified for (but not limited to)
chemotherapy, endoscopy and dialysis.
• Variation in same-day admission practice for subacute care (for example, rehabilitation)
was also evident, particularly influenced by different admission practices between the
private and public hospital sectors.
• Same-day care provided in private day hospitals may differ from that provided in other
private hospitals.
Recommendation
This report is specific to the reporting period 2013–14; the nature and extent of variation
identified here may differ from that for other reporting periods, as may the variation in policies
and practices that underlie it. For example, a service delivery model may change, a new
policy may be introduced, or data quality improvements may be made by jurisdictions and/or
individual hospitals. For this reason, there would be value in regularly updating this report
(for example, biennially), and conducting a more comprehensive review of admission
practice variation less regularly (for example, every 5 years).
Since the conclusion of this work, states and territories have agreed to provide admission
and separation time on a best endeavours basis for the national hospital data collection.
When these data are available, interpretation of admitted patient activity should be easier
because short-stay admissions (for example, admissions less than 4 hours) will be able to be
identified. At a national level, stakeholders have also agreed to consider other issues
identified in this report as part of ongoing national hospital data development work.
viii