Admitted patient safety and quality
The quality of care provided to patients admitted to hospitals can be measured in several ways. One way is to use data from hospitals to measure rates of:
- Staphylococcus aureus (‘golden staph’) bloodstream infections (SABSI)
- Hand hygiene compliance
- Hospital-acquired complications and adverse events
- Potentially preventable hospitalisations (PPHs).
Another way is to survey people about their experiences as hospital patients. Information gathered through hospital data and patient surveys does not cover all aspects of hospital safety and quality. Certain aspects of safety and quality—continuity of care and responsiveness of hospital services—are difficult to measure and are not included here.
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What is SABSI?
Staphylococcus aureus (also known as golden staph or S. aureus) is a usually harmless bacteria commonly found inside the nose and on the skin. However, if the bacteria enters the bloodstream a Staphylococcus aureus bloodstream infection (SABSI) can occur.
Contracting SABSI can be life-threatening and hospitals aim to minimise cases by implementing infection prevention and control policies, including good hygiene practices. Surveillance and reporting of healthcare-associated SABSI rates in hospitals helps to improve patient safety.
Types of SABSI
The two types of SABSI reported on are:
- methicillin-sensitive Staphylococcus aureus (MSSA) – which can be treated with commonly used antibiotics, and
- methicillin-resistant Staphylococcus aureus (MRSA), which resists treatment by many types of antibiotics, and is associated with poorer patient outcomes.
Data on healthcare associated infections associated with hospital care are presented in the following data visualisation and summarised in the sections below. The data presented are for the latest year for which national data are available, and over time.
Healthcare-associated infections
All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.
This data visualisation contains 4 tabs:
1. Column graph showing number and rate of SABSI in public hospitals for 2020–21
2. Line graph showing number and rate of SABSI in public hospitals over time from 2010–11 to 2020–21.
3. Table showing SABSI number and rates by hospital between 2010–11 and 2020–21. Data is able to be filtered by type of SABSI, public/private sector, hospital peer group.
4. Data notes.
Nationally, in 2021–22:
- there were 1,546 cases of SABSI in public hospitals during 21.1 million patient days of care – an average of 30 cases per week. This is equivalent to a rate of 0.73 cases per 10,000 public hospital patient days.
- 15% of SABSI cases were resistant to antimicrobial treatment (MRSA) and 85% were MSSA cases.
Of the 700 public hospitals in Australia that contributed data, 197 (33%) hospitals reported at least one SABSI case.
Rates varied by the type of hospital (peer group) – from 0.47 per 10,000 patient days in Small hospitals to 0.92 in Major hospitals which, along with Children's hospitals (0.82), are more likely to deliver services with a higher risk of SABSI.
Seven states and territories met the national benchmark
All states and territories achieved rates below the current nationally-agreed performance benchmark of 1.0 case per 10,000 patient days, except the Australian Capital Territory. Rates ranged from 0.62 in Western Australia to 1.08 in the Australian Capital Territory.
Trends over time
Overall, SABSI rates have decreased at the national level from 1.09 cases per 10,000 patient days in 2010–11 to 0.73 in 2021–22. Rates by state/territory fluctuate from year to year.
On 1 July 2020, the agreed national benchmark changed from no more than 2.0 cases of healthcare-associated SABSI per 10,000 days of patient care to no more than 1.0 case.
Since 2010–11, rates of healthcare-associated MRSA have also declined – from 0.29 cases per 10,000 patient days to 0.11 cases. These cases accounted for 27% of all SABSI cases in 2010–11 compared with 15% of all cases in 2021–22.
In 2021–22, 148 private hospitals (23%) voluntarily submitted SABSI data to the data collection. The rate of private hospital participation in the NSABDC was calculated using the 643 private hospital listed in the Australian Government Department of Health’s list of Commonwealth Declared Hospitals as at 31 October 2021. Due to the participation rate, data may not be representative of the private hospital sector as a whole. Also, data provided by public and private hospitals should not be compared, as the procedures, types of cases and patients treated, and therefore the risk of healthcare-associated SABSI in each sector, differ.
In 2021–22:
- there were 194 cases of SABSI in private hospitals during 5.7 million private hospital patient days. This is equivalent to a rate of 0.34 cases per 10,000 private hospital patient days.
- 8.8% of SABSI cases were resistant to antimicrobial treatment (MRSA) and 91% were MSSA cases.
The interactive table in the data visualisation above presents data on SABSI healthcare-associated infections by hospital between 2010–11 and 2021–22 – see 'Hospitals' tab. It includes both public and private hospitals.
See the Hospital Safety and Quality theme page for more data downloads for healthcare-associated infections in public and private hospitals.
Data are from the AIHW National Staphylococcus aureus Bacteraemia Data Collection (NSABDC). NSABDC data are supplied by all states and territories for public hospitals and participating private hospitals.
The SABSI rate is calculated as the number of healthcare-associated cases (patient-episodes) of Staphylococcus aureus divided by the total number of patient days under surveillance (x 10,000).
For more information about data quality and methods see:
Australian Commission on Safety and Quality in Health Care (ACSQHC) – Antimicrobial resistance
Australian Government Department of Health – Antimicrobial resistance
Health Direct – Staph infections
Previous releases
AIHW – Bloodstream infections associated with hospital care 2019–20
Definitions of the terms used in this section are available in the Glossary.
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Why is hand hygiene important?
Hand hygiene refers to the washing of hands or use of alcohol-based rubs. Good hand hygiene is a first-line defence against viruses and infections, such as COVID-19, influenza and Staphylococcus aureus bloodstream infections. This is especially important for hospital patients whose immune systems may already be weakened due to existing health conditions, or medical treatment they are undergoing, such as surgery.
How is hand hygiene measured in hospitals?
Hand hygiene amongst healthcare workers in hospitals is continuously monitored through hand hygiene audits, and data are reported for three consecutive audit periods a year for participating hospitals as part of the National Hand Hygiene Initiative (NHHI) coordinated by the Australian Commission on Safety and Quality in Health Care (ACSQHC). In the last audit period (November 2022 to March 2023), data are reported here for 619 public hospitals, which is over 90% of the 680 public hospitals listed on the Australian Government Department of Health’s list of Commonwealth Declared Hospitals as at 31 October 2022.
There are certain times when the risk of healthcare workers transmitting disease in hospitals is greater. Known as hand hygiene ‘moments’, these are:
- before touching a patient (Moment 1)
- before a procedure (Moment 2)
- after a procedure or body fluid exposure risk (Moment 3)
- after touching a patient (Moment 4)
- after touching a patient’s surroundings (Moment 5).
Hand hygiene compliance rates are calculated by dividing the number of compliant hand hygiene moments by the number of moments observed by auditors. Since 2017 the national benchmark for hand hygiene compliance has been 80%.
Hand hygiene compliance for each audit period is reported here for public hospitals at national, and individual-hospital levels, as well as by hand-hygiene moment and healthcare-worker group.
Hand hygiene
All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.
Hospitals and LHNs
This figure shows hand hygiene rates and observed hand hygiene moments for several audit periods. Data are presented by measure (hand hygiene rate and observed hand hygiene moments). Hospital and national data are available.
Time series
This figure shows hand hygiene compliance between 2012 and 2023. Data is presented by audit period and hospital.
Hand hygiene in public hospitals
The latest national-level data (from Audit period November 2022 to March 2023), show:
- the national hand hygiene compliance rate was 86% – above the 80% national benchmark
- hand hygiene for each of the 5 moments was also above the benchmark:
- before touching a patient: 83%
- before a procedure: 91%
- after a procedure or body fluid exposure risk: 93%
- after touching a patient: 89%
- after touching a patient’s surroundings: 81%
- the highest rates of hand hygiene were among:
- dental professionals, for example, dentists’ compliance was 94%
- nurses and midwives: 89%
- the following healthcare-worker groups did not meet the 80% benchmark:
- doctors (medical practitioners): 76%
- ambulance workers: 69%
- domestic staff (for example, food services, cleaning and maintenance workers): 76%.
The ACSQHC (2023) reports that for Audit period 1 of 2023 the highest rates of compliance were in departments for:
- dentistry: 93%
- renal care: 90%
- neonatal care, mental health care, ambulatory care, oncology/haematology, palliative care (89%).
Emergency department (78%) was the only department type that did not been the 80% benchmark.
Hand hygiene in your hospital
The interactive table in the data visualisation above presents data on hand hygiene by participating public hospitals from 2010 onwards – see 'Hospitals' tab.
Data downloads
See the Hospital Safety and Quality theme page for more data downloads for hand hygiene in public hospitals from 2010 onwards.
There are a number of factors contributing to hospital hand hygiene compliance rates, including the type of clinical care provided, hand hygiene product placement and availability; and staff awareness of and compliance with infection prevention and control strategies.
For more information about data quality and methods see:
- Hand Hygiene National Best endeavours data set, 2012– (data set specification)
- National hand hygiene data collection 2012– (quality statement).
The number of public hospitals is from the Australian Government Department of Health List of declared hospitals from 2022.
Related information
National Hand Hygiene Initiative (Australian Commission on Safety and Quality in Healthcare – ACSQHC)
The Australian Commission on Safety and Quality in Health Care (ACSQHC) lists 16 hospital-acquired complications for which clinical risk mitigation strategies may reduce the risk of occurrence. These hospital-acquired complications include pressure injuries, healthcare-associated infections, delirium, malnutrition, and neonatal birth trauma.
Highlights
In 2021–22:
- one or more hospital-acquired complications was reported for 146,000 hospitalisations from a potential 11.3 million hospitalisations
- 55% of hospital-acquired complications was for healthcare-associated infections affecting 81,000 hospitalisations
- other hospital-acquired complications included Delirium (17%), Cardiac complications (16%) and Respiratory complications (15%)
- the 20 most common hospital-acquired complications accounted for 87% of all hospitalisations where one or more hospital-acquired complications was reported
- the rate of hospital-acquired complications was 2.1 per 100 hospitalisations for public hospitalisations and 0.9 per 100 for private hospitalisations.
Changes over time
From 2017–18 to 2021–22, the rate of hospital-acquired complications has decreased for both public hospitals (from 2.6 per 100 to 2.1 per 100 hospitalisations), and private hospitals (from 1.1 per 100 to 0.9 per 100 hospitalisations).
Average length of stay for hospitalisations with at least one hospital acquired complication
In 2021–22, the average length of stay (ALOS) for overnight hospitalisations with at least one hospital-acquired complication was 20.6 days in public hospitals and 16.8 days in private hospitals, longer than the ALOS without a hospital-acquired complication reported (5.0 days and 4.7 days, respectively).
Patients with longer lengths of stay in hospital may already have a higher risk of acquiring a complication during the episode, and the occurrence of a hospital-acquired complication may further extend the hospital stay.
What other information is available?
Data on hospital acquired complications can be found in the Admitted patient care 2021–22: Safety and quality of health systems data tables, refer to tables 8.9–8.11.
More information, Appendixes and caveat information, and data tables are available in the Info & downloads section.
Definitions of the terms used in this section are available in the Glossary.
Average length of stay
The average length of stay for a patient is the average number of days between admission and separation.
Hospital-acquired complications
Hospital-acquired complications include conditions that:
- are newly arising conditions (for example, pneumonia, rash, confusion, hypotension, electrolyte imbalance or cyst)
- are abnormal reactions to, or later complications of, surgical or medical care (for example, post-procedural shock, disruption of wound or urinary tract infection)
- result from a misadventure during surgical or medical care (accidental laceration during procedure, medication error)
- have an impact on obstetric care—including complications or unsuccessful interventions of labour and delivery, or prenatal/postpartum management
- for neonates, it includes conditions in the birth episode arising during the birth event (conditions associated with birth trauma, neonatal aspiration, or newborn affected by delivery or intrauterine procedures) or conditions that arose following birth (for example respiratory distress, jaundice, feeding problems).
Data limitations
The clinical information available in the National Hospital Morbidity Database (NHMD) can be used to provide some information on the safety and quality of admitted patient care in hospitals, such as instances of actual or potential harm. However, the available information does not provide a complete picture. For example, there is no routinely available information on some aspects of quality, such as continuity of care or responsiveness of hospital services.
It should be noted that:
- the data in the NHMD are collected primarily for the purposes of recording care provided to admitted patients and that their use for purposes such as reporting adverse events has not been validated for accuracy in Australia
- it is not possible to identify adverse events or complications that arise after the patient was discharged. The results should therefore be treated with caution.
- the information presented for separate indicators in this chapter may not be mutually exclusive. This means that some individual events are counted in more than one indicator, so the overall total is less than the sum of the various indicators.
- the data for public hospitals are not comparable with the data for private hospitals due to differences in casemixes, such as the proportion of overnight and same-day care or the types of patients treated and treatments performed, and recording practices may also differ (for example, in the classification of some same-day care as either admitted or non‑admitted patient care).
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A condition onset flag (COF) is associated with each diagnosis. The COF identifies conditions that arose during a hospital stay (that is, conditions not present on admission). Some of these conditions may have been preventable, but others may not have been preventable.
For 2021–22, the COF data were provided for 100% of hospitalisations in public hospitals and 99% of hospitalisations in private hospitals – a similar level of coverage to the past five years.
In 2021–22 (based on data for which the COF was provided):
- 938,000 hospitalisations (8.3% of hospitalisations) recorded a condition that arose during the episode of care.
- 10% of public hospital hospitalisations recorded a condition that arose during the hospital stay compared to 5.3% of private hospital hospitalisations
- the Childbirth category had the highest proportion of hospitalisations with a condition that arose during hospital stay (48% for same-day hospitalisations and 67% for overnight hospitalisations), reflecting the conditions that arise after admission that impact on obstetric care (for conditions that affect the mother)
- for General Intervention (Surgical) (emergency), 30% of overnight hospitalisations had a condition that arose during hospital stay compared to 1.7% of same-day hospitalisations
- the most common condition which arose during hospital stay was Hypotension affecting 125,000 hospitalisations, followed by Perineal laceration during delivery (87,300) and Other disorders of fluid and, electrolyte and acid-base balance (81,700).
From 2017–18 to 2021–22 (based on data for which the COF was provided), the proportion of private hospital hospitalisations that recorded a condition that arose during a hospital stay decreased by 0.7% from 6.0% to 5.3%
Where do I find more information?
More information on type of care is available in Admitted patient care 2021–22: Safety and quality of the health system, refer to tables 8.5, 8.6, S8.7–S8.8.
More information on the coverage of COF data is available in Admitted patient care 2021–22: Appendix A tables, refer to table A3.
More information on the COF code is available on METEOR (686100).
Conditions that arose during the hospital stay
The National Hospital Morbidity Database (NHMD) includes ‘condition onset flags’ (COF) that can help to identify conditions that arose during hospital stay (that is, conditions that were not present on admission).
Conditions that arise during stay include adverse events (some of which may have been preventable) and therefore may provide information on the safety and quality of the care.
Conditions that arose during hospital stay include conditions that:
- result from a misadventure during surgical or medical care (e.g., accidental laceration, foreign body left in cavity, medical infusion error)
- are abnormal reactions to, or later complications of, surgical or medical care (e.g., postprocedural shock, disruption of wound, urinary tract infection)
- are newly arising conditions (e.g., pneumonia, rash, confusion)
- have an impact on obstetric care that arises after admissions, including complications or unsuccessful interventions of labour and delivery or prenatal/postpartum management (e.g., postpartum haemorrhage)
- affect neonates in the birth episode during birth events (e.g., respiratory distress, jaundice, feeding problems, neonatal aspiration, conditions associated with birth trauma, newborn affected by delivery of intrauterine procedures)
The flag is not assigned for conditions previously existing or suspected on admission – such as the presenting problem, co comorbidity, chronic disease, or disease status.
Data limitations
The clinical information available in the National Hospital Morbidity Database (NHMD) can be used to provide some information on the safety and quality of admitted patient care in hospitals, such as instances of actual or potential harm. However, the available information does not provide a complete picture. For example, there is no routinely available information on some aspects of quality, such as continuity of care or responsiveness of hospital services.
It should be noted that:
- the data in the NHMD are collected primarily for the purposes of recording care provided to admitted patients and that their use for purposes such as reporting adverse events has not been validated for accuracy in Australia.
- it is not possible to identify adverse events or complications that arise after the patient was discharged. The results should therefore be treated with caution.
- the information presented for separate indicators in this chapter may not be mutually exclusive. This means that some individual events are counted in more than one indicator, so the overall total is less than the sum of the various indicators.
- the data for public hospitals are not comparable with the data for private hospitals due to differences in casemixes, such as the proportion of overnight and same-day care or the types of patients treated and treatments performed, and recording practices may also differ (for example, in the classification of some same-day care as either admitted or non‑admitted patient care).
Potentially preventable hospitalisations (PPHs) are conditions where the hospitalisation could have potentially been prevented through preventative health interventions or early disease management.
Potentially preventable hospitalisations
All data in these visualisations are available for download in the Data & downloads section of the MyHospitals website.
Time series
This bar graph shows the number of potentially preventable hospitalisations per 1,000 population, between 2017–18 and 2021–22. Data is presented by type of potentially preventable hospitalisation (acute conditions, chronic conditions and vaccine preventable conditions). National data is available. In 2021–22, there were 23.1 potentially preventable hospitalisations per 1,000 population compared with 27.9 in 2017–18.
Sector
This bar graph shows the number of potentially preventable hospitalisations by public and private hospital sectors. Data is presented by type of potentially preventable hospitalisation (acute conditions, chronic conditions, vaccine preventable conditions and diabetes complications). National data is available. In 2021–22, there were 493,295 potentially preventable hospitalisations in public hospitals and 166,776 potentially preventable hospitalisations in private hospitals.
Highlights
In 2021–22:
- just over 1 in 17 (5.7%, 660,000) of all hospitalisations were classified as PPHs
- 3 in 4 PPHs (75%) were in public hospitals, which reflects that public hospitals experience a larger number of emergency or unplanned admissions. Private hospitals focus more on planned or ‘elective’ admissions. For example, private hospitals provided 175,000 emergency medical procedures and 1.4 million non-emergency medical procedures, whilst public hospitals provided 2.3 million emergency medical procedures and 2.5 million non-emergency medical procedures
- the most common acute PPH was Dental conditions (79,000 hospitalisations, or 25% of acute PPHs)
- the most common chronic PPH was iron deficiency anaemia (64,000 hospitalisations, or 21% of chronic PPHs)
- 94% of PPHs were for Acute conditions (48%) or Chronic conditions (46%) and a small proportion were for Vaccine preventable conditions (7%). A hospitalisation can be classified as multiple PPH types based on relevant diagnoses recorded.
Variation in PPH across population groups
In 2021–22:
- for Indigenous Australians, the rate of PPHs per 1,000 population was 65 – this was 3 times the rate for other Australians (22 per 1,000 population)
- the overall rate of PPHs was highest for residents of Remote and Very remote areas (38.6 and 58.6 per 1,000 population, respectively) and lowest for residents of Major cities (21.5 per 1,000)
- the rate of PPHs generally decreased with increasing levels of socioeconomic advantage, ranging from 17.7 per 1,000 for residents of the highest socioeconomic areas to 26.6 per 1,000 for residents of the lowest socioeconomic areas.
Changes over time
From 2017–18 to 2021–22, rates of PPHs decreased from 27.9 per 1,000 population to 23.1 per 1,000 population, an annual average decrease of 4.7%.
This decrease in the number of PPHs was greatest for Vaccine preventable conditions (16.1% annually), possibly reflecting the impact of measures implemented to stop the spread of COVID-19 or other viral illnesses such as influenza.
What other information is available?
More information about these data are available in tables 8.1–8.4 and S8.2 in Admitted patient care 2021–22: Safety and quality of the health system.
Definitions of the terms used in this section are available in the Glossary.
Potentially preventable hospitalisations
Potentially preventable hospitalisations (PPHs) are conditions where hospitalisation could have potentially been prevented through the use of appropriate and individualised preventative health interventions and early disease management.
The rate of PPHs is a National Healthcare Agreement (NHA) performance indicator, relating to the outcome area ‘Australians receive appropriate high quality and affordable primary and community health services’. Selected potentially preventable hospitalisations is also an indicator of the health system’s effectiveness under the Australian Health Performance Framework.
Hospitalisation rates for PPHs are viewed as indicators of the quality or effectiveness of non-hospital care. A high rate of PPHs may indicate an increased prevalence of the conditions in the community, poorer functioning of the non-hospital aspects of the health care system or an appropriate use of the hospital system in response to greater need.
There are 3 broad categories of PPHs:
- Vaccine-preventable—diseases that can be prevented by proper vaccination. These conditions themselves are considered to be preventable, rather than the hospitalisations
- Acute—conditions that may not be preventable, but theoretically would not result in hospitalisation if adequate and timely care (usually non-hospital) was received
- Chronic—conditions that may be preventable through behaviour modification and lifestyle change, but can also be managed effectively through timely care (usually non-hospital) to prevent deterioration and hospitalisation.
A more detailed analysis of selected potentially preventable hospitalisations can be found in the data tables, refer to Table S8.2.
Indigenous status
The quality of the data reported for Indigenous status has not been formally assessed. However, all states and territories consider the Indigenous status data used to be of a quality appropriate for publication.
Remoteness area of usual residence
Remoteness area of usual residence is defined by the physical distance of the location of the patients’ usual residence from the nearest urban centre. The categories of remoteness area are:
- Major cities
- Inner regional areas
- Outer regional
- Remote areas
- Very remote areas
Socioeconomic status of usual residence
ED presentations by socioeconomic status (SES) of area of usual residence are presented by SES quintiles (fifths). The lowest SES group represents the areas containing the 20% of the population with the most disadvantage and the highest SES group represents the areas containing the 20% of the population with the least disadvantage.
The Australian Bureau of Statistics (ABS) conducts an annual survey, Patient Experiences. This survey collects data on the access and barriers to, and satisfaction with healthcare services. This section contains results from the survey on patient experiences during hospital admissions and emergency department visits.
Cohort characteristics
From the survey, among people aged 15 and over in 2021–22, in their previous 12 months:
- 12.8% had been admitted to a public or a private hospital and 14.8% had visited a hospital emergency department (ED)
- those with a long-term health condition were more likely than those without a long-term condition to be admitted to hospital (17.9% compared with 7.1%) and visit an ED (20.1% compared with 8.9%)
- those aged 85 years and over were more likely than those aged 15–24 years to be admitted to hospital (22.8% compared with 7.9%) and visit a hospital ED (23.7% compared with 16.7%)
- those living in areas of most socio-economic disadvantage were more likely than those living in areas of least disadvantage to be admitted to hospital (13.4% compared with 12.3%) and visit a hospital ED (16.5% compared with 12.2%)
- those living in outer regional, remote or very remote areas were more likely to be admitted to hospital than those living in major cities (15.0% compared with 12.1%) and visit a hospital ED (18.0% compared with 13.6%).
Experience of hospital care
Of those who used hospital services as an admitted patient, most people reported:
- hospital doctors and specialists always spent enough time with them (73%), always listened carefully (76%) and always showed respect (79%)
- hospital nurses always spent enough time with them (74%), always listened carefully (78%) and always showed respect (80%).
Of those who visited a ED, most people reported:
- hospital ED doctors and specialists always spent enough time with them (64%), always listened carefully (66%) and always showed respect (72%)
- hospital ED nurses always spent enough time with them (70%), always listened carefully (73%) and always showed them respect (76%).
What other information is available?
For more information about patient experience data, refer to the Australian Bureau of Statistics’ Patient Experiences survey.