Objectives: To describe the statewide projections of acute inpatient activity in New South Wales.Methods: Data on acute inpatient activity in NSW for the period 1998-1999 to 2003-04 were derived from the Admitted Patient Data Collection. Regression analysis was used to project trends in utilisation and length of stay by age group, clinical specialty groups and stay type (day-only and overnight). The projected separation rates and length of stay were subject to clinical review. Projected separation rates (by age group, clinical speciality and stay type) were applied to NSW population projections to derive the projected number of separations. Bed-days were calculated by applying projected overnight average length of stay.

A review of projection methodologies used to project sub-acute inpatient activity in various international health care jurisdictions was undertaken as part of a project to develop subacute inpatient activity projections for the state with the largest population in Australia. The literature search identified nearly 200 articles and found three main groups of projection methodologies: projections with a focus on subacute care; projections with a focus on acute care, but which often included subacute activity in the overall projections; and projections of specific diseases/conditions influencing the demand for subacute care.In terms of the examples in the literature specifically regarding subacute care, the most common method of estimating current or future need was the use of normative benchmark ratios of beds to population. This was mainly to provide a policy basis to encourage development of subacute services, but also because of convenience.In the literature regarding acute activity projection methodologies, many incorporated subacute activity in the overall activity measures of the acute hospital unit. The most common method of acute care activity projection was use of current or trended utilisation rates applied to population projections. It appears that a significant amount of planning and demand projection being undertaken internationally on subacute care takes place within acute care methodologies.In regard to the potential use of specific diseases/ conditions that drive demand for subacute care, such as stroke or cancer, it is suggested that the best use of these disease-specific projections is in reality testing the results of other modelling. What is known about the topic? With ageing of the population, subacute care is growing as an important area requiring specific planning methods to estimate current and future demand. However, internationally there is no consensus about the definition of subacute care or which projection method is more appropriate. What does this paper add?The literature review shows there are several methods being used internationally for estimating and projecting subacute care. Both demographic and non-demographic influences, a focus on patient activity rather than beds and scenario modelling were identified as important aspects. What are the implications for practitioners? Practitioners can choose from several different methods for estimating future demand for subacute care, depending on the degree of complexity required.

We describe the development of a method for estimating and modelling future demand for suband non-acute inpatient activity across New South Wales, Australia to 2016. A time series linear regression equation was used, which is consistent with projection models found in the literature.Results of the modelling indicated an increase in rehabilitation, palliative care and maintenance episodes and bed-days. Projections for other categories of care are problematic due to smaller levels of activity and data quality issues. This project indicated a need for ongoing monitoring of type-changing by facilities and management of data quality. Local planners will need to consider a range of factors when considering the applicability activity projections at a local level, particularly THE ACUTE INPATIENT projection tool used by the NSW Health Department, aIM2005, incorporates subacute activity in its modelling, applying the same methodology for acute and subacute activity. 1 This methodology had not been validated for subacute care, which was seen as a key missing element within the planning process. Health service planners, particularly in rural regions, had requested assistance to develop a more consistent and systematic approach to sub-and non-acute care given the disparate nature of this activity.In late 2005, the New South Wales Health Department initiated a project requiring development of a methodology for estimating and modelling future demand for sub-and non-acute inpatient activity across NSW to 2016. 2 The objective of the project was to provide NSW with a well researched and credible projection methodology that can be used to model future demand (and potentially supply) of sub-and non-acute inpatient services. The methodology included consideration of factors that influence overall demand for these services and also the variation in demand across NSW, including: ■ Population demographic effects such as growth and ageing to 2016;

During 2006, NSW and ACT Health Departments jointly engaged KPMG to develop an Operating Theatre Requirements’ Projection Model and an accompanying planning guideline. A research scan was carried out to identify drivers of surgical demand, theatre capacity and theatre performance, as well as locating existing approaches to modelling operating theatre requirements for planning purposes. The project delivered a Microsoft Excel-based model for projecting future operating theatre requirements, together with an accompanying guideline for use of the model and interpretation of its outputs. It provides a valuable addition to the suite of tools available to Health staff for service and capital planning. The model operates with several limitations, largely due to being data dependent, and the state and completeness of available theatre activity data. However, the operational flexibility built into the model allows users to compensate for these limitations, on a case by case basis, when the user has access to suitable, local data. The design flexibility of the model means that updating the model as improved data become available is not difficult; resulting in revisions being able to be made quickly, and disseminated to users rapidly. What is known about the topic? In New South Wales there has been no documented, consistent, robust planning methodology to guide the estimated future requirements for operating and procedural suites, nor recommendations available to determine the number of operating theatres that provide optimal efficiency. What does this paper add? Opportunities to design and build new operating suites rarely arise. There is a great deal of uncertainty about future surgical models of care and recent history shows that technology and development of new procedures and approaches have greatly changed the nature of the theatres and rooms required for many interventions. This paper describes the process of developing a planning methodology to estimate the future operating suite capacity required to meet forecast future surgical demand across New South Wales for both metropolitan and rural Area Health Services. What are the implications for practitioners? Although now used only in the New South Wales public sector, the methodology can easily be applied to planning requirements for operating theatres in the private sector.