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National Health Performance Authority: Hospital Performance: Average length of stay (ALOS) for multi-day stay patients in Australian public hospitals, 2013-2015

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termAverage length of stay for multi-day stay patients
Synonymous names:Help on this termALOS
METeOR identifier:Help on this term584301
Registration status:Help on this termNational Health Performance Authority (retired), Retired 01/07/2016
Description:Help on this termThe average (mean) length of stay for multi-day stay patients within a given Australian Refined Diagnosis-Related Group (AR-DRG) in Australian public hospitals.
Indicator set:Help on this termNational Health Performance Authority: Hospital performance: 2011-16 National Health Performance Authority (retired), Retired 01/07/2016

Collection and usage attributes

Computation description:Help on this term

To calculate the average length of stay the key unit that records information about a patient's stay in hospital is called an 'episode of admitted patient care'. This records information about the patient and the care they received in hospital, including:

  • Sex
  • Diagnosis
  • Procedure type
  • Date of admission and
  • Date of separation/discharge.

Exclusions:

The average length of stay indicator relates only to acute patients with a multi-day, or overnight, stay. The following episodes of care are excluded from all reported measures:

  • Same day episodes, i.e. patients admitted and discharged on the same day
  • Episodes for non-acute care
  • Episodes where the patient died
  • Episodes where the patient transferred to another facility within 2 days.

Outlier removal: 

Episodes determined to be extreme long stay outliers were removed. Outlier bounds are derived for each AR-DRG. The method selected for deriving national level outlier bounds uses the inter-quartile ranges as the guide for outlier exclusion. The method of detecting extreme outliers (mEO) is as follows:

mEO = Q3 + k*(Q3-Q1)

 

Where

Q1 equals the 25th percentile value

Q3 equals the 75th percentile value

k equals non-negative values of a constant.

Sensitivity analysis was conducted to identify k and resulted in k=10 being selected.

This method is complemented by a minimum for the outlier bound of 20.

 

Reporting of results:

Average length of stay is reported for the following AR-DRG (version 6.0x). The average length of stay is only reported for Australian public hospitals that have at least 10 multi-day stays within a given AR-DRG.

Selection of AR-DRG (version 6.0x) codes and meanings

AR-DRG code

AR-DRG meaning

E65A

Chronic Obstructive Pulmonary Disease with complications

E65B

Chronic Obstructive Pulmonary Disease without complications

F62A

Heart Failure with complications

F62B

Heart Failure without complications

G07B

Appendix removal

H08B

Gallbladder removal

I03B 

Hip replacement

I04B

Knee replacement

J64B

Cellulitis

L63A

Kidney and urinary tract infections with complications

L63B

Kidney and urinary tract infections without complications

M02B

Prostate removal

N04B

Hysterectomy

N06B

Gynaecological reconstructive procedures

O01C

Caesarean delivery

O60B

Vaginal delivery

 

Computation:Help on this termNumerator ÷ denominator
Numerator:Help on this termNumber of overnight bed days attributable to a given AR-DRG for an Australian public hospital.
Numerator data elements:Help on this term
Data Element / Data SetEpisode of admitted patient care—length of stay (excluding leave days), total N[NN]
Data Source
Admitted Patient Care National Minimum Data Set (APC NMDS)
Data Element / Data SetEpisode of admitted patient care—major diagnostic category, condition/procedure code AR-DRG (version 6.0x) ANNA
Data Source
Admitted Patient Care National Minimum Data Set (APC NMDS)
Denominator:Help on this termNumber of multi-day stays attributable to a given AR-DRG for an Australian public hospital.
Denominator data elements:Help on this term
Data Element / Data SetEpisode of admitted patient care—major diagnostic category, condition/procedure code AR-DRG (version 6.0x) ANNA
Data Source
Admitted Patient Care National Minimum Data Set (APC NMDS)
Disaggregation:Help on this term

Disaggregation is by:

  • Australian public hospital by AR-DRG
  • Peer group by AR-DRG
Disaggregation data elements:Help on this term
Data Element / Data SetEstablishment—organisation identifier (Australian), NNX[X]NNNNN
Data Source
Admitted Patient Care National Minimum Data Set (APC NMDS)
Data Element / Data SetHospital—hospital peer group, modified code N
Guide for use

Comparison of hospital results to a peer result for average length of stay is available for major, large and medium hospitals as these hospitals account for the vast majority of episodes of care and bed days for the selected AR-DRGs.

Specialist women’s and children’s hospitals are treated separately for this indicator. Women’s hospitals are presented as part of the major metropolitan group for childbirth, hysterectomy, and gynaecological reconstructive procedures and contribute to the peer group average.

Children’s hospitals were identified as having high numbers of stays for appendix removal, cellulitis, chronic obstructive pulmonary disease without complications, and kidney and urinary tract infections without complications. For these conditions, they form their own peer group (excluding women’s hospitals) and comparisons are presented on the MyHospitals website.


Representational attributes

Representation class:Help on this termMean (average)
Data type:Help on this termTime period
Unit of measure:Help on this termTime (e.g. days, hours)
Format:Help on this termDays, rounded to 1 dp

Indicator conceptual framework

Framework and dimensions:Help on this termPAF-Efficiency

Data source attributes

Data sources:Help on this term
Data SourceAdmitted Patient Care National Minimum Data Set (APC NMDS)
Frequency
Annual
Data custodian
Australian Institute of Health and Welfare

Accountability attributes

Reporting requirements:Help on this termNational Health Performance Authority
Organisation responsible for providing data:Help on this termAustralian Institute of Health and Welfare
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