Inpatient hospitalizations in Canada increase slightly after many years of decline

The majority of Canada’s inpatients are hospitalized for reasons other than surgery

November 30, 2005 – New data made available today from the Canadian Institute for Health Information (CIHI) show that, in the last two years, the downward trend in inpatient hospitalizations in Canada and the upward trend in the average number of days Canadians stay in hospital have both levelled off.

After declining every year between 1995–1996 and 2002–2003, Canada’s acute care hospitals experienced slight increases in hospitalizations in both 2003–2004 and 2004–2005. Even when inpatient hospitalization numbers are adjusted to account for Canada’s growing and ageing population, the downward trend in hospitalizations is still seen to be levelling off. Furthermore, while the average length of stay in hospital has been on the rise over the past decade, in 2003–2004, it decreased from 7.0 days to 6.9 days and then remained the same in 2004–2005.

Inpatient hospitalizations and average lengths of stay continue to vary across Canada

The increase in the total number of inpatient hospitalizations in 2004–2005 (up by 0.8% to 2,161,848) was primarily due to increases in three provinces: Ontario (up 20,980), British Columbia (up 3,716) and Alberta (up 3,140). The Yukon Territory also saw an increase, with an additional 250 hospitalizations. The remaining provinces and territories (excluding Quebec) all had declining inpatient hospitalizations. New Brunswick reported a decrease of 5,036, while Newfoundland and Labrador had 2,101 fewer hospitalizations, Saskatchewan had 1,617 fewer, and Nunavut saw a decrease of 51. Quebec had an increase of 17,178 inpatient hospitalizations in 2003–2004, the most recent year for which data were available to CIHI.

On a per capita basis, there were 8.4 hospitalizations for every 100 Canadians in 2004–2005. There continues to be considerable variation among provincial and territorial hospitalization rates in comparison to the national average. Some provinces, such as Prince Edward Island and Saskatchewan, were well above the national average (almost 12 hospitalizations per 100 residents), while other provinces, such as Manitoba and Alberta, were only slightly above the average (about 9.4 hospitalizations per 100 residents). Only Ontario and British Columbia were below the average (about 7.7 hospitalizations per 100 residents). All of the territories continue to have hospitalization rates over the national average.

For three provinces—Saskatchewan, Alberta and British Columbia—there was no change in average number of days patients stayed in hospital, which was the case for Canada as a whole. The Northwest Territories, Manitoba, Nova Scotia and Newfoundland and Labrador all saw increases in average lengths of stay, while the remaining provinces and territories experienced decreases. Quebec saw a decrease of 1.1% in average number of days spent in hospital in 2003–2004.

Acute inpatient hospitalizations and average lengths of stay vary across the country for a number of reasons, including differences in health status, in the way in which health care systems are structured and in the criteria used to determine hospital admission.

Overall changes in hospitalizations and lengths of stay in Canada over the past 10 years indicate shifts in types of patients being hospitalized

Over the past decade, while inpatient hospitalizations declined by 13%, the average number of days spent in hospital increased by 3%. In 1995–1996, acute care hospitals handled 2.5 million hospitalizations, and the average length of stay was 6.7 days. Ten years later, hospitalizations were down to 2.2 million in 2004–2005, but the average length of stay was up to 6.9 days. The fact that the number of Canadians being hospitalized decreased over the last 10 years, while the average number of days spent in hospital increased, is reflective of a shift in the types of patients being hospitalized and how they are being treated.

“Patients who would have been hospitalized 10 years ago for treatment of a particular condition, such as tonsillitis, are now receiving ambulatory care instead, such as same day surgery,” says Nizar Ladak, CIHI’s Director of Health Services Information.

Most of Canada’s inpatient hospitalizations are not for patients having surgery

According to CIHI’s data, most admissions to Canada’s acute care hospitals in 2004–2005 were for medical treatments other than surgery. Only a little over a quarter (27%) of Canada’s inpatient hospitalizations were for patients having surgery, while the largest proportion (41%) was categorized as “medical” patients. These are adult patients who are most frequently treated for such conditions as digestive diseases, respiratory diseases (for example, pneumonia and bronchitis), heart diseases and diabetes. The remaining hospitalizations were for maternal care (13%), newborns (11%), pediatrics (5%) and mental health (3%).

In addition to accounting for the most hospitalizations in Canada, medical patients also stayed longer in hospital (8.9 days) than any of the other patient groups, except for mental health (14.0 days). Surgical patients had the third-longest average length of stay (5.4 days), followed by pediatric patients (5.1 days). Maternal care and newborn patients spent the least amount of time in hospital (2.6 days and 3.0 days, respectively).

The majority of Canadians who are hospitalized start off in emergency departments

In 2004–2005, over half (53%) of all Canadians who were hospitalized were admitted via an emergency department. These patients stayed, on average, nearly three days longer (8.0 days compared to 5.1 days) than patients admitted by other means, such as planned admissions, direct admissions from a doctor’s office or clinic, or transfers from another facility. Medical patients were the most likely patient group to be admitted from an emergency department, with over three-quarters (77%) starting off in an emergency department. In comparison, the majority (66%) of surgical patients were admitted by other means.

More than 10% of hospitalized Canadians spend time in special care units

In 2004–2005, slightly more than 1 out of 10 (11%) patients hospitalized in Canada spent time in a special care unit (“special care unit” refers to all specially equipped inpatient units in which constant supervision and monitoring are provided to seriously ill patients). Burn care units, neonatal care units and cardiac care units are examples of special care units found in Canada’s acute care facilities. The average number of days in hospital for these patients (14.5 days) was more than twice that for other patients (5.9 days). About 1 out of 7 (14%) medical patients were in need of special care unit services, more than any other patient group. The 1 out of 10 surgical patients who needed special care services were found to stay in hospital longer than all other patients, at 20.3 days on average.

About inpatient hospitalizations

The data in this release are derived from an “Analysis in Brief” that presents the latest available data from CIHI’s national Hospital Morbidity Database and Discharge Abstract Database. Data from Quebec for fiscal year 2004–2005 were not available to CIHI at the time of the data release.

For the purposes of this release, “inpatient hospitalization” refers to the entirety of an event in which a person is admitted to an acute care hospital as an inpatient, stays in hospital and is discharged (via release or death). Inpatient hospitalization rates are important measures of illness in the population and utilization of inpatient hospital services over time. The inpatient hospitalization statistics reflect the number of hospitalizations, which is somewhat higher than the number of individuals hospitalized, since individuals with multiple admissions during a single year would be counted more than once in the discharge totals. Inpatient hospitalization data refer to acute inpatient events only and exclude patients treated in other types of care facilities, such as emergency departments, chronic care and rehabilitation units and day surgery programs.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. For more information, visit