Hospital safety and quality

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 2019–20, 2.1% (113,000) of hospitalisations in public hospitals had at least one hospital-acquired complication, and 1.0% (37,000) of hospitalisations in private hospitals had at least one hospital-acquired complication in private hospitals.

The highest rates were related to healthcare associated infections (affecting 63,000 hospitalisations in public hospitals and 18,000 hospitalisations in private hospitals) and cardiac complications (affecting 19,000 hospitalisations in public hospitals and 9,000 hospitalisations in private hospitals).

The bar chart shows the average length of stay in both public and private hospitals for overnight hospitalisations with and without a hospital-acquired complication in 2019–20. The average length of stay for overnight hospitalisations with a hospital-acquired complication was 9.8 days for public hospitals and 9.4 days for private hospitals. Whilst the average length of stay for overnight hospitalisations without a hospital-acquired complication was 4.1 days for public hospitals and 4.4 days for private hospitals.

Unplanned readmissions

An unplanned or unexpected readmission occurs when a patient has been discharged from hospital following surgery, is admitted again to the same hospital within a certain time interval, and the reason for the readmission is for a complication following surgery. In this report, the interval is within 28 days of selected types of surgery.

Reducing avoidable hospital readmissions improves patient safety and health outcomes and leads to greater efficiency in the health system. In 2019–20, rates of unplanned readmissions in public hospitals were highest for Tonsillectomy and adenoidectomy, Hysterectomy and Prostatectomy (Figure 5).

The bar chart shows the number of unplanned readmissions for selected procedures in 2019–20. The number of unplanned readmissions for tonsillectomy and adenoidectomy procedures was 41.5 per 1,000 hospitalisations. The number of unplanned readmissions for cataract extraction procedures was 3.0 per 1,000 hospitalisations.

What do patients say about their hospital experience?

The Australian Bureau of Statistics (ABS) conducts an annual survey to monitor Australian’s experiences using a range of healthcare services as part of the Multipurpose Household Survey. People who have received hospital care or emergency department care are asked about their experiences with health professionals (ABS 2021).  

Admitted patients

Among people who received hospital care in 2020–21:

  • 92% of patients responded that doctors ‘always’ or ‘often’ listened carefully to them in hospital
  • 93% of patients responded that doctors ‘always’ or ‘often’ showed respect
  • 93% of patients responded that nurses ‘always’ or ‘often’ listened carefully to them in hospital
  • 93% of patients responded that nurses ‘always’ or ‘often’ showed respect

Emergency department

Among people who attended an emergency department in 2020–21:

  • 82% of patients responded that doctors ‘always’ or ‘often’ spent enough time with them in the emergency department.
  • 86% of patients responded that nurses ‘always’ or ‘often’ spent enough time with them in the emergency department.
  • 88% of patients responded that doctors ‘always’ or ‘often’ showed respect to them in the emergency department.
  • 91% of patients responded that nurses ‘always’ or ‘often’ showed respect to them in the emergency department.

Where to go for more information

Hospital safety and quality - Australian Institute of Health and Welfare

Australian Commission on Safety and Quality in Health Care 

Patient Experiences in Australia: Summary of Findings, 2020-21 financial year | Australian Bureau of Statistics