NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Perpetrator type is identified using the fifth character subdivisions in the first external cause code (see codes tab for more detail). The total includes a small number of records for assault not requiring a five character external cause code. The records without the fifth character are code Y87.1 - sequelae of assault.
Only NSW residents are included. Rehabilitation episodes are excluded. Figures are based on where a person resides, rather than where they are treated. Hospital separations were classified using ICD-10-AM. Rates were age-adjusted using the Australian population as at 30 June 2001.
Records relating to acute hospital transfer and statistical discharge were excluded.
Numbers for recent years include an estimate of the small number of hospitalisations of NSW residents in interstate public hospitals, data for which were unavailable at the time of production. Further details can be found in the Methods tab in the following HealthStats NSW indicator: http://www.healthstats.nsw.gov.au/Indicator/bod_hos_cat
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
Hospitalisations for interpersonal violence include injuries from assaults inflicted by another person with intent to injure by any means, including bodily force (such as punching, pushing or submersion), weapons, objects or substances. Both perpetrators (ie those with intent to injure) and victims (ie those who are the target of the assault or are uninvolved bystanders) may be hospitalised for injuries related to interpersonal violence.
It is important to note that these hospitalisations include only those patients sustaining injuries severe enough to be admitted to hospital. These figures do not include those patients treated in hospital emergency departments and discharged without admission.
Most of the analyses are based on the place of residence of the person, rather than the place they were treated, or, in the case of an injury, the place the injury occurred. It should be noted that the injury that led to a person's hospitalisation might not have occurred in the area in which the person resided. For example, metropolitan residents may be injured in motor vehicle crashes while travelling in regional or remote areas. The location where injury was sustained is not routinely recorded in hospitalisation statistics.
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) (NCCH 2006) groups injury according to the body region which is affected by injury (head, neck chest etc) and the type of injury (superficial, fracture, amputation etc). Relevant codes are ICD-10: S00 to T98. Another way of categorising injury is by the circumstances of injury or the activity being undertaken when injured (transport accidents, assaults, intentional self-harm etc). This group is covered by ICD-10 codes U50-Y98 called ‘external causes’ (NCCH 2006).
In HSNSW hospitalisations and deaths due to injury are classified by the external cause of injury. This is because this classification is the most important in prevention planning.
In HealthStats NSW, injury hospitalisation data exclude records with source of referral being a transfer from another hospital or a type change admission in order to reduce multiple counting of hospitalisation episodes relating to the same injury incident. Some injury and poisoning hospitalisations require subsequent hospitalisations for rehabilitation. To avoid counting multiple hospitalisations following one injury event, rehabilitation is generally excluded. However, in order to demonstrate the burden of injury, specific comparisons that include rehabilitation are also presented.
Injury in primary diagnosis and external cause of injury
The majority of injury and poisoning hospitalisations have a principal diagnosis of injury and poisoning, but there is also a substantial number of hospitalisations where injury or poisoning is in an additional diagnosis (about 20%-30% of total records with injury and poisoning anywhere on record). Some of these hospitalisations are linked to a prior episode of hospitalisation with an injury in principal diagnosis, that has not been counted, due to the methods used to minimise multiple-counting of hospitalisations following one injury event, as explained in 'Rules for excluding records in analysis of hospitalisation for injury'.
Consequently, it is important to note whether an analysis included any hospitalisation records with external cause of injury or only those records that had injury and poisoning as the principal diagnosis.
Injury deaths may be reported following a method which takes account of multiple causes of death (Henley G et al. 2007). The multiple causes of death method includes a death as an injury death if:
• the underlying cause of death was coded to ICD-10 V01–Y36, Y85–Y8, or Y89, or
• there is any cause of death coded to ICD-10 S00–T75 or T79 (AIHW Cat. no. AUS 122 2010) (see above for the categories of codes).
The resulting count is called injury-related deaths and has been adopted in the Australia’s health 2010 report by the AIHW (AIHW Cat. no. AUS 122 2010).
The difference in count depending on the method applied could be as high as 25% in the same year (8,000 injury deaths in Australia in 2005 according to a straightforward method and 10,000 using the multiple causes of death).
In this report a straightforward method of counting injury death has been used and the resulting count is based solely on the underlying cause of death coded to ICD-10 V01–Y36, Y85–Y8, or Y89 and the corresponding ICD-9 codes.
Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376
Henley G, Kreisfeld R, Harrison J. Injury deaths, Australia 2003-04.. Injury research and statistics series no. 31. AIHW cat. no. INJCAT 89. Adelaide: AIHW, 2007. Available at
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Australian Coding Standards. Sydney: NCCH, 2006.
All NSW public hospitals, public psychiatric hospitals, public multi-purpose services, private hospitals and private day procedure centres in NSW report data on patients admitted for care to the NSW Ministry of Health. Patient separations from developmental disability institutions and private nursing homes are not included. These reported data, from about 400 different facilities in NSW, are called the NSW Admitted Patient Data Collection (APDC).
The collection also includes data relating to NSW residents hospitalised interstate (see below in Imputation for more details) and in Commonwealth Department of Veterans’ Affairs facilities.
Each reporting facility has its own Patient Administration System (PAS), there are five types of these in NSW: HNMA Millenium (administered by Cerner), WinPAS, iPM (I-Soft), HOSPAS (legacy system being phased out and replaced with other systems) and ISCOS, which is the Inpatient Statistics Collection On-line System used by private hospitals. Data from the PAS systems are loaded into the Health Information Exchange (HIE) in a standard format. The HIE is the data warehouse for the whole NSW health system maintained by the NSW Ministry of Health which is accessed by authorised staff across the health system and in the NSW Ministry of Health. Data from the HIE are extracted and loaded onto the Secure Analytics for Population Health Research and Intelligence (SAPHaRI) warehouse, administered by the Centre for Epidemiology and Evidence and used for this report.
The Admitted Patient Data Collection (APDC) is a census of all inpatients treated in NSW and includes data on NSW residents treated in other states. The APDC was, up to 2002, known as the Inpatient Statistics Collection. The APDC contains approximately 70 variables and is based on a financial year cycle beginning on 1 July and ending on 30 June of the following year.
The APDC data used in this report are from the SAPHaRI (Secure Analytics for Population Health Research and Intelligence) data warehouse, maintained by the Centre for Epidemiology and Evidence. The APDC data is extracted from the Health Information Exchange (HIE) and undergoes a quality assurance and standardisation process before being loaded onto SAPHaRI in a SAS dataset format.
Further information on the APDC and SAPHaRI is available in this report in Methods tab under The Admitted Patient Data Collection title.
3.1 Principal diagnosis and additional diagnoses coded to the ICD-9-CM and ICD-10-AM
Each hospital episode in the APDC is described by a principal diagnosis and additional diagnoses, which are coded using the International Statistical Classification of Diseases and Related Health Problems: ICD-9-CM (up to June 1998) and ICD-10-AM (from July 1998 onwards).
In this report the count of hospitalisations for a condition is based mainly on principal diagnosis. If an indicator contains analysis of data in additional diagnosis fields as well ('comorbidities'), this is clearly stated in the title of an indicator and in the Notes. The Notes specify how many additional diagnosis fields were included in the analysis. Another exception is the topic of injury and poisoning where the count is based on ‘external cause of injury’. See Methods for injury and poisoning indicators.
The number of additional diagnoses that are included in the hospital records is restricted to conditions which fulfil several requirements, including direct relevance to the treatment and management of the principal diagnosis. This ensures that only the most resource intensive or clinically relevant conditions are listed for that hospitalisation rather than all comorbidities that a patient may have. Data on additional hospital diagnoses cannot therefore be used to estimate the prevalence of a condition in the community.
3.2 Procedures coded to Australian Classification of Health Interventions
Procedures performed in Australian hospitals are coded in medical records using the Australian Classification of Health Interventions (ACHI) published by the National Centre for Classification in Health. This classification is based on the Commonwealth Medicare Benefits Schedule and relates to anatomy rather than surgical specialty.
Up to 30 June 1998, the ICD-9-CM Procedure Classification was used in Australia. This was based on WHO Surgical procedures (edition 5) and was not revised and carried beyond 1998 by the WHO due to the rapid advancements in the field of procedures (National Coding Centre 1996).
On 1 July 1998, both the ACHI and the ICD-10-AM were introduced in NSW. They are revised every two years. The ICD-10 is the WHO classification but the AM suffix stands for Australian Modification, which adds detail necessary to describe practice in Australian hospitals. The ICD-10-AM is fully compatible with ICD-10 (NCCH 2006).
Up to the fourth edition of ICD-10-AM in 2004, the ACHI was published as a part of the ICD manuals (volume 3 and 4), from the fifth edition in 2006 the titles of the ACHI publication emphasise that this is a classification independent from the ICD.
Both ICD-9-CM Procedure Classification (up to and including 1997-98) and Australian Classification of Health Interventions (from 1998-99 onwards) are used in this report.
3.3 Episode of care based count of hospitalisations
The count of hospitalisations in this report is based on an episode of care from 1 July 1998 (ISC EOC datasets on SAPHaRI). A patient can have several episodes of care during one hospital stay, that is, between the formal admission and the formal discharge (separation) from hospital.
The episode of care is defined by a service category. An episode of care starts when the hospital stay starts or when the service category changes. There are ten service categories: acute care, rehabilitation care, palliative care, maintenance care, newborn care, other care, geriatric evaluation and management, psychogeriatric care, organ procurement-posthumous and hospital boarder.
A new episode of care starts also when a patient is on leave from hospital: more than 4 days away from any hospital and more than 10 days away from psychiatric hospitals.
3.4 Overnight and day-only hospital stays are included
Both overnight and day-only hospitalisations are included in this report, unlike in the national reporting on hospital statistics (AIHW Health services series no. 40. Cat. no. HSE 107 2011), where day-only hospitalisations are not included.
The only exceptions are the count and rate of hospitalisation for falls in elderly (persons aged 65 years and over) in NSW, where day-only hospitalisations are excluded from the key indicator reports in NSW. NSW performance reporting of hospitalisations for falls in elderly in NSW includes overnight (and longer) hospitalisations. However, in this report, an analysis of day-only hospitalisations and the total of overnight and day-only hospitalisations are also included in the relevant indicator for comparison and completeness.
3.5 Full census of hospitalisations from 1993-94 and sampling factor prior to 1993-94
In 1993-94 the APDC (then known as the Inpatient Statistics Collection) was a fully enumerated survey (that is a census) for the first time. Datasets containing financial years earlier than 1993-94 are based on estimates from a sample of all inpatient data in some hospitals, partiularly in rural areas, and their use in analysis requires the inclusion of a sampling factor weighting variable.
3.6 Separation date determines the year of hospitalisation
The main record file of the hospital stay for a patient is created or completed on separation from hospital when all relevant documentation is made available to hospital medical record departments. Consequently, the main reason for hospitalisation (principal diagnosis) completed at separation, may be different from the admitting diagnosis. The hospitalisation is counted in the year when the separation took place even if the hospitalisation period occurred predominantly in the previous financial year. For example a patient discharged on 1 July after a 4 week hospital stay would be counted as hospitalised in the new financial year.
3.7 Imputation of interstate hospitalisations in the last year of data
At the time when the NSW Ministry of Health completes the Admitted Patient Data Collection for the previous financial year, data on hospitalisations of NSW residents in other states are usually not available and so interstate hospitalisations for the latest year is always ‘imputed’ from the previous three years in this report. This imputation process estimates the number of hospitalisations occurring in other states for each diagnosis in previous years and adds these numbers to the latest year of data. When the actual data become available, the number and rates for the affected year are re-calculated.
3.8 Summary of major changes in the hospital data on SAPHaRI
1988-89: Hospital data included from the Inpatients Statistics Collection (ISC) counted on the basis of a "period of stay" in hospital (ie multiple episodes of care). ICD-9-CM used and sampling from some hospitals (requiring a sampling factor for weighting numbers in these hospitals).
1993-94: Admitted Patient Data Collection (APDC) is a fully enumerated census of hospitalisations.
1998-99 onwards: APDC starts to be counted as episodes of care. ICD-10-AM replaces ICD-9-CM; and Australian Classification of Health Interventions replaces ICD-9-CM Procedure Classification.
Imputation for interstate hospitalisations: The latest year of data (number and rates) are ‘imputed’ for missing interstate hospitalisations for NSW residents. The actual number of interstate hospitalisations is included when available.
4.1 Differences in publication schedules
The APDC dataset is continuously updated because it is not uncommon to receive additional records or additional information on records already supplied well after the close of a financial year. Consequently data on hospitalisations in NSW from different sources, such as this report and the AIHW report, will always differ slightly due to different publication schedules.
4.2 Imputation of interstate hospitalisations in the latest year of data
In this report imputation methods are used to estimate the number of hospitalisations of NSW residents occurring elsewhere in Australia in the latest year due to a lag in receiving this information (see above). Over some periods of time two last years of data need to be imputed. Refer to Notes in the indicator for confirmation how many years are imputed at the time. Estimates may vary slightly from the estimates in other releases of this report or other reports because of the imputation. The actual number of interstate hospitalisations is included when relevant.
4.3 Definition of hospitalisation
Both overnight and day-only hospitalisations are included in this report, unlike in the national reporting on hospital statistics, where only overnight hospitalisations are included (AIHW Health services series no. 40. Cat. no. HSE 107 2011).
4.4 Different projected populations
For the calculation of rates, the NSW Ministry of Health uses population projections based on the population projections prepared by the NSW Department of Planning. Refer to Methods in Population-Demography topic for further information on projected populations and other issues mentioned here. The rates in this report are expressed as a number per 100,000 population.
Rates published by the Australian Institute of Health and Welfare may be expressed differently (per 1,000 or 10,000 population) and use different projected population estimates for NSW. The population estimates, which are not projected, are likely to be the same, as these are based on the estimated residential populations published by the ABS.
The APDC datasets contain information on inpatient hospital activity. Emergency department data and Outpatient activity data are also available to report on hospital activity.
Australian Institute of Health and Welfare. Australian hospital statistics 2009–10. Health services series no. 40. Cat. no. HSE 107. Canberra: AIHW, 2011. Available at http://www.aihw.gov.au/publication-detail/?id=10737418863 (Cited on April 2011).
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Australian Coding Standards. Sydney: NCCH, 2006.
National Coding Centre. The Australian version of the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM). Sydney: University of Sydney, 1996.
The NSW Combined Admitted Patient Epidemiology Data (CAPED) records all inpatient separations (e.g. discharges, transfers and deaths) from all public, private, psychiatric and repatriation hospitals in NSW, as well as public multi-purpose services, private day procedure centres and public nursing homes. The CAPED includes data on hospital admissions of NSW residents which occurred in public hospitals interstate.
In CAPED, public hospital data are recorded in terms of episodes of care. An 'episode of care' ends with the patient ending a period of stay in hospital (e.g. by discharge, transfer or death) or by becoming a different 'type' of patient within the same period of stay. For private hospitals, each CAPED record represents a complete hospital stay. CAPED records are counted based on the date of separation (discharge) from hospital.
Data from interstate hospitals for recent years may not yet be available when the data are analysed for publication. This may affect analyses and has a greater effect on rates for areas closer to an interstate boundary. Analyses by geographical regions and analyses involving uncommon diagnoses or procedures are particularly affected. Therefore, an estimate is made of interstate admissions for recent years of hospitalisations based on interstate admissions in the most recent year for which interstate data are available. Interstate admissions records from the most recent year for which interstate data are available are copied into the file for the most recent years, assuming that the attributes of these admissions (such as sex, age, geography, type of diagnosis or procedure) provide the best predictor of those for admissions in the recent years.
|Description||ICD-9 & ICD-9-CM||ICD-10 & ICD-10-AM||Comments|
This indicator uses the first external cause code.
All records are included for NSW residents only. Rehabilitation records are excluded, unless otherwise stated.
Codes refer to the type of assault: firearm discharge, knife, blunt object etc
|Perpetrator||not available||0= spouse or domestic partner; 1= parent; 2= other family member; 3= carer; 4= acquaintance or friend; 5= official authorities; 6= person unknown to the victim; 7= multiple persons unknown to the victim; 8= other specified person; 9= unspecified person.||
Fifth character subdivisions used with the codes X85-Y09. For example: X95.20 is Assault by shotgun discharge by spouse or domestic partner; X95.40 is Assault by large calibre rifle discharge by spouse or domestic partner;Y00.00 is Assault by blunt object by spouse or domestic partner.
Available from 1 July 2002.
• There were around 3,000 injury-related deaths in 2017 and 188,103 injury-related hospitalisations in 2018-19 in NSW.
• Injury and poisoning is the leading cause of death among people aged 5 to 44 years.
• Males have much higher rates of death and hospitalisation than females for all major injury causes, except for falls among older people.
• The rate of hospitalisation for injury and poisoning in Aboriginal people was 1.7 times that of non-Aboriginal people in NSW in 2018-19.
• Rates of death and hospitalisation from injury and poisoning are higher in remote and regional areas than in metropolitan areas.
Injury can be described by the single or multiple body regions which are affected by the injury, by the type of injury itself or by an agency which caused the injury.
Examples of the injuries described by body regions are: injuries to the head, injuries to the hip and thigh or injuries involving multiple body regions.
Types of injury are: superficial injury (such as abrasion, contusion, insect bite), open wound (animal bite, cut, laceration, puncture wound), fracture (closed or open, which refers to the surface of skin), dislocation, sprain or strain, injury to nerves and spinal cord, injury to blood vessels, injury to muscles, fascia and tendon, crushing injury, traumatic amputation, injury to internal organs.
Examples of environmental events and circumstances causing injury, poisoning or other adverse events are: transport accidents, falls, exposure to electrical current, exposure to forces of nature, assaults, intentional self-harm, complications of medical and surgical care. This classification of injury and poisoning is the most important in prevention planning. These events are also known as 'external causes' of the injury.
Injury has a major, but often preventable, influence on Australia’s health. It affects Australians of all ages and is the greatest cause of death in the first half of life. It leaves many with serious disability or long-term conditions. Injury was estimated to account for 8.5% of the burden of disease in 2015.
For each person who dies of injuries there are several thousand individuals who survive and are left with permanent disabilities. Hospitalisation data provide an indication of the incidence of the more severe injuries.
Injury prevention involves the collaboration of governments, the private sector and communities in order to create safer environments and cultures.
Effective injury prevention strategies have been developed for a wide range of potential causes of injury. For example, balance and strength training is effective in reducing falls in older people, fencing around private swimming pools has reduced childhood drownings, and seat-belt and drinking-driving legislation together with measures relating to vehicle and road design have greatly increased road safety.
New South Wales Injury Risk Management Research Centre at http://www.irmrc.unsw.edu.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
WorkCover NSW at http: www.workcover.nsw.gov.au
Youthsafe at http://www.youthsafe.org
Kidsafe NSW at http://www.kidsafensw.org
Sportsafe at http://www.sma.org.au
Water Safety at http://www.watersafety.nsw.gov.au/
NSW Falls Prevention Network at http://fallsnetwork.neura.edu.au/
healthdirect at http://www.healthdirect.gov.au
NSW Falls Prevention Program: NSW Clinical Excellence Commission: http://www.cec.health.nsw.gov.au/patient-safety-programs/adult-patient-safety/falls-prevention