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Hospitals and health care far from equal

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Almost 10 per cent of all hospital admissions are potentially avoidable, and some hospitals are taking up to twice as long as the national average to treat their patients, a national assessment of the health care system has found.

There were more than 635,000 potentially avoidable hospital admissions in 2011-12, which between them chewed up 2.5 million hospital bed days – 9 per cent of all hospital bed days – according to the National Health Performance Authority.

The Authority based its findings on the definition of 21 chronic, acute and vaccine-preventable conditions for which hospitalisation could have been avoided with timely and effective primary and preventive health care – a finding that suggests boosting resources for primary care could go a long way toward relieving pressure on stretched public hospitals.

The report, Healthy Communities: selected potentially avoidable hospitalisations in 2011-12, identified significant geographical variations in rates of preventable hospitalisations, particularly in rural and regional areas.

It particular, it found that people living in Tasmania had the lowest rate of potentially preventable hospitalisations (1098 hospitalisations per 100,000 people), while among those living in Victoria’s Great South Coast Medicare Local catchment the hospitalisation rate was 2809 per 100,000.

In a separate report, Hospital performance: length of stay in public hospitals in 2011-12, the Authority identified similar wide variations in the speed with which hospitals discharged patients.

The study was based on data collected from 125 public hospitals regarding the provision of treatment for 16 different conditions or procedures, including childbirth, cellulitis, heart failure, kidney and urinary tract infections, gall bladder removal and hip and knee replacements.

It compared how long patients were staying in different hospitals for similar conditions or procedures, and identified surprisingly wide variations.

For instance, the average time taken to treat and discharge patients with cellulitis varied between a little more than two day and almost five-and-a-half days, while removing the gall bladder and subsequent recovery could take between as little as one day and as long as three days.

In each instance, the Authority was careful to limit comparisons to those between similar hospitals, based on size and location.

In its report, the Authority noted that although shorter stays indicated greater hospital efficiency, it was important to make sure they were not so short that they compromised the quality of care.

At the same time, a longer-than-average stay suggested opportunities for a hospital to improve its practices and more quickly free up hospital beds to treat other patients.

While acknowledging that longer stays may be due to complications, they may also be caused by delays in coordinating care between health professionals, or because of hold-ups in transferring patients to other facilities such as an aged care home.

Of the 16 conditions and procedures included in the study, heart failure with complications resulted in the long average period of hospitalisation, 9.9 days, while gall bladder removal (1.9 days) and vaginal birth (2.5 days).

Adrian Rollins