Hospitals held up to scrutiny on performance indicators

Public Health

By Tessa Hoffman

1 Feb 2018

The latest snapshot of Australia’s public hospital performance reveals a rise in adverse events and widespread variations  in waiting times for elective procedures.

An annual report by the Productivity Commission compares all 701 public hospitals on key performance indicators including wait times for elective surgery and rates of unplanned readmissions after surgery, along with adverse events and ‘sentinel’ events – hospital system failures that cause serious harm or death.

When it comes to elective surgery there is marked variation in hospital performance between the states and territories.

Wait times vary, the national average wait at the 50th percentile for a total knee replacement was 193 days in 2016-17. But in NSW waiting lists were a much longer 289 days, while in Victoria it was just 97 days.

There is also variation in the number of unplanned readmissions following surgery.

Nationally, 23 in every 1000 patients who had a knee replacement was readmitted due to a complication in 2015-16.

The rate was more than double in Northern Territory where 56 in every 1000 had unplanned readmissions, while 36 in every 1000 Tasmanians were readmitted. In the ACT the rate drops to 9 in every 1000 surgeries.

“Patients might be readmitted unexpectedly if the initial care was inadequate, or for reasons outside the control of the hospital for example poor post-discharge care,” the Productivity Commission notes in the report.

Nationally, the number of adverse events jumped to 6.6% of all hospital stays in 2015-16, up from 6.1% four years earlier, with a total of more than 400,000 incidents including 155,000 adverse reactions to medication and over 22,000 misadventures during surgical or medical care.

The rate was highest in Tasmania (8%) and lowest in the Northern Territory (3.4%).

However, the number of life-altering or fatal adverse events caused by hospital deficiencies has fallen to its lowest level in five years, the Commission notes.

A total of 82 ‘sentinel’ events recorded in 2015-16, down from 97 in 2011-12.

Sentinel events include procedures involving the wrong patient or body part that result in death or major disability, patient suicide, retainment of objects after surgery requiring further procedure and incorrect medication error leading to patient death.

The Productivity Commission notes that “over time an increase in the number of sentinel events reported might reflect improvements in incident reporting mechanisms and cultural change, rather than an increase in the frequency of such events”.

 The report also shines a spotlight on age profile differences across the medical workforce.

The Northern Territory has the youngest workforce, with 38% of doctors aged 30-39 and 13% aged 60 plus. In comparison, one in five hospital doctors in NSW are over 60.

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