There are many systems and mechanisms operating to ensure the safety and quality of hospital services in Australia. These include the regulatory arrangements surrounding medicines and devices, health facilities and the health workforce, the development of clinical standards and guidelines by the Australian Commission of Safety and Quality in Healthcare and the clinical governance arrangements that help ensure policies and practices are continually reviewed and issues responded to.
Beyond these specific institutions and measures, substantial research effort is put into monitoring and improving care quality for particular illnesses and procedures. This often involves specific research projects and data sets as well as the use of more ongoing data collections such as clinical quality registers and the AIHW’s National Hospital Morbidity Database. Patient experience surveys can also provide an indication of the quality of care provided from the patient’s perspective.
Some specific high-level measures that are used to monitor the safety and quality of hospital services include:
- Staphylococcus aureus blood stream infections (SABSI) acquired in hospital
- hospital-acquired complications such as birth trauma
- unplanned readmissions soon after being discharged from hospital.
Staphylococcus aureus bloodstream infections
Staphylococcus aureus (also S. aureus, or ‘Golden staph’) is a type of bacteria that can cause bloodstream infection (SABSI).
SABSI can be acquired after a patient receives medical care or treatment in a hospital. Contracting a Staph. aureus bloodstream infection while in hospital can be life-threatening and hospitals aim to have as few cases as possible. The nationally agreed benchmark for public healthcare-associated Staphylococcus aureus bloodstream infections is no more than 2.0 cases of healthcare-associated SABSI per 10,000 days of patient care for public hospitals in each state and territory.
In 2019–20, there were 1,428 SABSI cases occurring during 20.1 million days of patient care under surveillance. This represents a rate of 0.71 SABSI cases per 10,000 patient days.
Most SABSI cases (83%) were methicillin-sensitive and therefore treatable with commonly used antimicrobials.
Hospital-acquired complications
A hospital-acquired complication is a complication that arises during a patient’s hospitalisation which may have been preventable, and which can have a severe impact on both the patient and the care required.
Hospital-acquired complications include pressure injuries, healthcare-associated infections, malnutrition, neonatal birth trauma, cardiac complications, and delirium. They may affect a patient’s recovery, overall outcome and can result in a longer length of stay in hospital. A patient may have one or more hospital-acquired complication during a hospitalisation.
In 2020–21, 2.0% (112,000) of hospitalisations in public hospitals had at least one hospital-acquired complication, and 0.9% (36,000) of hospitalisations in private hospitals had at least one hospital-acquired complication.
The highest rates were related to healthcare associated infections (affecting 61,000 hospitalisations in public hospitals and 17,000 hospitalisations in private hospitals), delirium (affecting 19,000 hospitalisations in public hospitals and 7,000 hospitalisations in private hospitals) and cardiac complications (affecting 18,000 hospitalisations in public hospitals and 8,000 hospitalisations in private hospitals).