A national report on the state of clinical performance in healthcare organisations for the last eight years has been published and was launched in Melbourne today at The Great Healthcare Challenge Conference.

The “Australasian Clinical Indicator Report 2003-2010: Determining the Potential to Improve Quality of Care“ (12th edition) has been released today by the Australian Council on Healthcare Standards (ACHS) and presents only detailed analysis of clinical indicators on a national basis.

ACHS Chief Executive, Mr Brian Johnston said the analysis of each indicator set for the last eight years means the data is statistically more relevant than ever before, due to the increasing input from healthcare organisations (HCOs) nationwide.

“With a wide range of HCOs contributing to the Report, we are receiving a wealth of rich data that point to key trends across the 22 clinical indicator sets, ranging from Adverse Drug Reactions to Surgery,” he said.

“The response from HCOs to our concerted push in recent years to promote the Report to the Colleges has been considerable, and the more HCOs contribute, the higher quality the information becomes.

Key improving trends in the Australasian health sector over the last seven years include:

Intensive Care Units

o Three indicators point to improvement in addressing ICU access block;
- ICU non-admission due to inadequate resources dropped to only 2.3% from 57,793 ICU admissions across 66 ICUs.  This is an improvement from the indicator rate of 5% in 2003, which reached a high of 7% in 2004.
- Elective surgery deferred or cancelled due to the unavailability of an ICU bed was 1.2% from 47,709 ICU admissions across 56 ICUs, a reduction from 3% in 2003.
- Only 0.8% of patients were transferred to another facility or area due to unavailability of an ICU bed, from 45,296 ICU admissions from 56 ICUs.  The indicator rate was 1.3% in 2003.
Context:  Occupancy rates in ICUs are often high resulting in limited reserve capacity for several days each month (known as ICU access block), and is a key indicator of resources.

o The percentage of patient deaths reported while receiving a clinical audit process has improved from 78% (when introduced in 2005) to 95% in 2010, from 17, 626 deaths reported from 195 HCOs.
Context: It is appropriate for patient deaths occurring in a HCO to be analysed through clinical audit and review processes to facilitate identification and introduction of any necessary improvements for safety.

o A significant improvement in the substantial compliance of anaesthetic records from 91% in 2003 to 97% in 2010, from 124, 917 records, as reported by 67 HCOs.
Context:  A complete anaesthetic record is an essential part of the patient’s medical record, and should chart all aspects of management relevant to the anaesthesia.

o Improvements in the Mental Health indicator set were seen in the areas of timely documentation of diagnosis on admission and discharge, the rate of discharge on multiple medications (more than three) from the same chemical sub-group, and in all six indicators relating to suicide, assault, self-harm and injury.
Deteriorations across the health sector include:
o The rate of prolonged stay in the Emergency Department (ED) of more than eight hours (access block) was 335 from 534,757 across 53 EDs.  This is an increase on ED access block of 26% in 2003.  The number of patients going through EDs has increased by one third since 2003, indicating a large increase in patient load, and a system under pressure.  Some HCOs however, are managing to achieve very low access block rates.  Additionally, Western Australia recorded the lowest access block rate in 2010, NSW the highest.
Context:  Hospitals are responsible for having a bed management system which  minimises access problems for emergency patients requiring admission to an inpatient  unit.

o Of the 2,326 mental health separations reported from 50 HCOs, the rate of inpatients having seclusion for more than four hours was 53 per 100 separations.  This indicator rate was 26 per 100 separations in 2003, and has steadily deteriorated in the last seven years.  There is also a large variation between the 20th and 80th centiles, indicating there is potential for system-wide improvement.

Context:  Access to mental health facilities and the use and safety of seclusion in patient  care should be reviewed.
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Media information: ACHS Communications Manager, contact Ian McManus on +61 2 9281 9955, or M 04111 59941 or via email imcmanus [at] achs [dot] org [dot] au, or visit the ACHS website http://www.ahs.org.au/Clinical Indicators/

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