Accreditation, Quality & Safety

Measures of Hospital Performance

At Healthscope, we take quality and safety seriously. To help patients make informed decisions, Healthscope publishes indicators which reflect the quality and safety of its network of 44 hospitals. Healthscope is proud to be the first private hospital group in Australia to publish the results of its clinical performance and health outcomes on its website. This is just one part of our program to continually maintain and improve our high standards of quality and safety.

Quality can be defined and measured in many ways. At Healthscope, quality is not just a simple measure – it is a comprehensive look at many aspects of a patient's experience. We have chosen to publish a range of clinical and safety measures which provide you with information about our performance in providing safe, quality healthcare. Click on the links below to view Healthscope data averaged across our 44 hospitals.

Accreditation
Rehabilitation Health Outcomes
Infection Rates
Patient Falls
Emergency Department Waiting Times
Unplanned Readmission to Hospital
Unplanned Return to Theatre

To view data for each Healthscope hospital, see: Healthscope Hospitals

Many organisations today are measuring quality in health care using varying criteria. Evaluating this information can be difficult and time-consuming since not all measures reflect the same information from one report to another. However, it is important for patients to ask questions and look at quality information to ensure they are getting the efficient and effective care they need.

Healthscope supports transparent public reporting of healthcare quality data and actively participates in initiatives of the following organisations.

Australian Commission on Safety and Quality in Healthcare (ACSQHC) – The Australian Commission on Safety and Quality in Healthcare (the Commission) was established in 2006 by the Australian, State and Territory Governments to lead and coordinate national improvement in safety and quality. Healthscope has representation on the Private Hospital Sector Advisory Committee and several key working groups.

Australian Institute of Health and Welfare - The Australian Institute of Health and Welfare (AIHW) is a major national agency set up by the Australian Government under the Australian Institute of Health and Welfare Act to provide reliable, regular and relevant information and statistics on Australia's health and welfare.

MyHospitals Website – This website lists all public and private hospitals in Australia, along with information about waiting times for elective surgery and emergency department access. Healthscope has representation on the MyHospitals Development Advisory Committee.

If you would like more information about the pros and cons of public reporting, see: Public Reporting Literature

Patient Stories

The experiences of our patients are another gauge of how well we are doing at caring for patients and their families.

To have a look at what they say, see: Patient Stories

Accreditation

All Healthscope hospitals are fully accredited against one of two accreditation schemes accepted by the Australian Government. Accreditation is conducted against either the Australian Council on Health Care Standards (ACHS), Evaluation and Quality Improvement standards (EQuIP) or ISO 9001 standards.

Accreditation involves a visit to the hospital from an independent team of expert health professionals who review the quality and safety of services provided. Our achievements are measured against industry standards by this review team. Hospitals are measured against many different criteria including patient care planning, medication management, the consent process, medical records, infection control, complaints management and staffing. Hospitals receive a rating for each one of these criteria.

For hospitals accredited by ACHS, a higher level of award is sometimes given – this is referred to as “EA” or “extensive achievement”.

This chart shows the proportion of “EA” ratings achieved by Healthscope hospitals for the most recent accreditation surveys conducted, in comparison with other Australian hospitals . Healthscope hospitals have achieved a higher proportion of EA ratings than other hospitals.

To view data for each Healthscope hospital, see: Healthscope Hospitals

Healthscope corporate office is also accredited by ACHS using the EQuIP Corporate Program. This accreditation looks at how well we run our 44 hospitals, and measures the entire organisation against criteria such as risk management, occupational health & safety, human resources, quality improvement, IT service delivery and consumer involvement. The graph shows that the corporate office achieved a very high proportion of EA ratings (12 out of 29) at the most recent accreditation survey (Organisation Wide) in November 2010.

Other Awards

Healthscope is proud of the recognitions of excellence bestowed on its hospitals and staff.

Examples of recent awards are:

Knox Private Hospital (VIC) awarded 2010 Victoria and Tasmania Employer Award.
Brisbane Waters Private Hospital (NSW) awarded for Community Partnership receiving the 2011 Industry Partnership Award from Hunter TAFE.
National Capital Private Hospital (ACT) awarded the Best Workplace Health and Safety Management System in the Private Sector for the ACT for 2010.
National Capital Private Hospital (ACT) was awarded Outstanding Achievement at their accreditation in 2010 for Care and Services that are planed, developed and delivered based on the best available evidence and in the most effective way – in particular relationship to work and achievements in VTE prevention.Broadwater
Dunsborough Medical Centres group (WA) was awarded the Royal Australian College of General Practitioners (RACGP) West Australian Practice of the Year Award 2010.
Knox Private Hospital (VIC) awarded an Outstanding Achievement at their accreditation survey in 2009 for Infection Control and Sterilisation procedures.
The Geelong Clinic (VIC) awarded Outstanding Achievement at their accreditation survey in 2009 for research and the integration of research findings in the treatment of depression and other mental illnesses. Research led by Professor Michael Berk.
The Melbourne Clinic (VIC) was a finalist in the 2010 EOWA Business Achievement Awards for Outstanding Workplace Flexibility Achieved through Job Design for an innovative evening program designed by Day program Manager, Lily Shatkin. The Melbourne Clinic (VIC) in 2009 won an Equal Opportunity Award for innovative and flexible working conditions for women.
Ashford Hospital (SA) nurse, Shani Dean was awarded South Australia's Midwife of the Year 2009.
Clinical neuropsychologist, Dr Wayne Reid, at Brisbane Waters Private Hospital and The Sydney Clinic (NSW) won the prestigious Cornelli Award 2009 for his work researching Parkinson's Disease and Dementia. His study was a twenty-year neuropsychological study which showed increasing age is an important factor in determining the prognosis in Parkinson's disease. Jacqueline McDonald - Mount Hospital (WA) was a finalist in the WA Enrolled Nurse of the Year Awards 2008. She designed a hand splint used in shoulder arthroscopies in Australia and overseas. It’s known as the "McDonald Splint".
Prince of Wales Private Hospital (NSW) midwife Anne Carter received the Midwife of the Year award 2008 from among 1100 nominations in NSW. The Australian College of Midwives Executive Officer said the award gives patients the opportunity to extend their own personal thanks to the midwives who had a positive impact on their family's life.
Prince of Wales Private Hospital (NSW) Bookings and Beyond Project was the winner of the 2009 Healthscope Service Excellence Recognition Awards in the quality improvement category.
RN Maureen Eddison, Prince of Wales Private Hospital (NSW) winner of the Healthscope Service Excellence Recognition Awards 2010 individual award category for team work.
Ringwood Private Hospital (VIC) was awarded the state and national award of the year in 2009, by Look Good, Feel Better, a community service program dedicated to helping women undergoing cancer treatment to manage the appearance related side effects of chemotherapy and other treatments to restore their self-image and self-esteem.
National Capital Private Hospital (ACT) was awarded Outstanding Achievement at their accreditation in 2010 for Care and Services that are planned, developed and delivered based on the best available evidence and in the most effective way – in particular relationship to work and achievements in VTE prevention

Safety and Quality Improvement Programs

Healthscope hospitals have a wide range of programs and protocols, which focus on the continuous enhancement of safety and optimal health care for all patients, visitors and employees.

Ten Tips for Safer Healthcare

Consistent with the Australian Commission on Safety and Quality in Health Care (ACSQHC), Healthscope recognises the potential for enhanced safety by engaging our patients in a safety partnership.

The Commission has produced a fact sheet designed to assist patients in hospital to become more actively involved in their own health care. It explains how things can go wrong and provides tips for improving patients’ health care. It provides an outline of the kind of information that can reasonably be expected from the patient’s health care professional, how to find out more about the patient’s condition, how to manage medication and what to do if patients have concerns about their health care.

For further details on this health care fact sheet, see: 10 Tips for Safer Healthcare

WHO Surgical Safety Checklist and Timeout Process

At Healthscope hospitals where surgery and procedures are performed, we follow the Royal Australian College of Surgeons’ Implementation Guidelines for ensuring correct patient, correct side and correct site surgery as well as the WHO Guidelines for Safe Surgery 2009. The protocol involves the use of a Surgical Safety Checklist and a surgical team “Time Out” for patient verification, confirmation of the procedure, the procedure side and site, patient allergy status and other key elements of a safe surgery.

Venous Thromboembolism (VTE) Prevention

VTE is a blood clot in the veins or lungs that can be a complication of hospital treatment. Healthscope hospitals use the guidelines published in the “Prevention of Venous Thromboembolism: Best Practice Guidelines for Australia and New Zealand 5th Edition October 2010”. The guidelines recommend treatment for patients at risk of VTE. The extent of treatment is dependent on the patient’s clinical risk factors. VTE prophylaxis (preventative measures) occur in consultation with the patient’s doctor and may include:

Mechanical graduated compression stockings (GCS) or intermittent pneumatic compression (IPC) devices including foot pumps.
Pharmacological prophylaxis (drugs to reduce the risk of VTE), for example, low dose unfractionated heparin (UFH) or low molecular weight heparin (LMWH)

National Inpatient Medication Chart

The National Inpatient Medication Chart (NIMC) is a major initiative of The Australian Commission on Safety and Quality in Health Care (ACSQHC). The NIMC is designed to improve the safe use of medicines through the standardisation of medication ordering in hospitals, with a common medication chart in use at all public and private hospitals in Australia.

In its summary rationale for a national medication chart”, The ACSQHC explains that ensuring a hospital patient receives the best therapy in a safe, accurate manner is a complex process involving many health professionals including doctors, pharmacists and nurses. A critical element of this process is the communication of the prescription. Evidence suggests this communication can be made safer if the process is standardised and made with a better understanding of safety principles. For example if a nurse or doctor works in both a public and a private hospital, the medication charts used in both settings will be very similar. The clinicians’ familiarity with the layout of the medication chart helps to reduce inadvertent errors.

The use of the National Inpatient Medication Chart has proven to reduce the risk of medication errors. Twenty Healthscope hospitals are participating in an audit of the National Inpatient Medication Chart run by the Australian Commission on Safety & Quality in Healthcare. This will help to ensure that the chart is being used correctly and safely for every patient.

Obstetric Care

All hospitals that have obstetric care dial into a regular teleconference to discuss improvements and best practice. A specialised e-learning training package has been introduced to ensure that nursing staff are up to date with the latest practice in areas such as Electronic Foetal Monitoring, Shoulder Dystocia, Newborn Care and Post Partum Haemorrhage.

Blood Transfusion

Our hospitals have policies and procedures in place to make sure blood transfusions are managed smoothly. Our policies are referenced to the latest guidelines and documents from the National Blood Authority (NBA), National Health & Medical Research Council (NHMRC) and Australasian Society of Blood Transfusion (ASBT). Nursing staff involved in blood transfusions have completed an e-learning “Bloodsafe” training package. We regularly liaise with the Australian Red Cross Blood Service to ensure that our practices are consistent and comply with all requirements. The National Transfusion Committee addresses any issues arising and ensures that hospitals and pathology services work well together.

Patient Centred Care

All hospitals conduct patient surveys each quarter and results of these are compared from site to site to make sure any issues are addressed. Healthscope has trialed a new project in 6 of our hospitals during 2010/11 that has involved specific customer service and patient-centred care education programs for nursing staff, and introduction of patient-centred care strategies (such as bedside handover). The patients were then surveyed again to find out about their experience in hospital. The project has shown good results and is currently being rolled out to all hospitals.

X-ray and Diagnostic Imaging

Healthscope have achieved Diagnostic Imaging accreditation (2nd stage) for 34 hospital-based and 4 stand-alone diagnostic imaging services. All services are currently accredited until 2015 and we were the first major hospital group to achieve the 2nd stage accreditation.

Rehabilitation Health Outcomes

Patient abilities, mobility and independence are measured on admission to our hospitals and again on discharge so that we can measure the improvement made. Patients demonstrate improvement in their abilities, mobility and independence after treatment at Healthscope hospitals. We use the FIM™ (Functional Independence Measure) to measure the success of rehabilitation. This is an established scale, used worldwide.

Improvement in patient abilities will depend on factors such as patient age, severity of condition on admission and other medical problems such as diabetes or dementia. For example if a hospital has a high number of patients over the age of 75 years, compared with other hospitals, the patient abilities may not improve so much.

Orthopaedic Fracture Rehabilitation

This graph shows the average improvement in patients at Healthscope Hospitals following rehabilitation after a broken bone. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals.

Rehabilitation for Hip, Knee or Shoulder Replacement

This graph shows the average improvement in patients at Healthscope Hospitals following rehabilitation after a hip, knee or shoulder replacement. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals.

Stroke Rehabilitation

This graph shows the average improvement in patients after stroke rehabilitation at Healthscope Hospitals. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals.

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to continually improve our patients’ rehabilitation

Improvement strategies may vary from hospital to hospital. Examples are:

Individual and group therapy – individualised therapy time which may include practising tasks of daily living
Multi-disciplinary team assesses and works with patient to set and meet goals
Use of Functional Electrical Stimulation (FES) to improve strength and function in stroke patients
Depression screening for all stroke patients (if depressed not able to participate fully in rehabilitation)
Swallowing and speech/language therapy by Speech Pathologists

Infection Rates

All Healthscope hospitals have infection control procedures, and staff take every precaution to prevent infections. However, some patients have a higher risk of acquiring an infection in hospital. Patients with wounds, invasive devices (such as drips) and weakened immune systems are at greater risk of infection than the general public. We need to avoid infections because they may cause illness to the patient, resulting in a longer stay in hospital and a longer recovery time.

What are Healthcare Associated Infections?

Healthcare associated infections (HAI) are infections that occur as a result of healthcare interventions and are caused by micro-organisms such as bacteria and viruses. They can happen when you are being treated in hospital, at home, in a GP Clinic, a nursing home or any other healthcare facility.

Some infections occur after an invasive procedure such as surgery and can be treated with antibiotics. However there are some infections such as Methicillin Resistant Staphylococcus aureus (MRSA) and Clostridium Difficile that are more difficult to treat because they are resistant to certain antibiotics.

The risk of getting these infections depends on how healthy you are, how long you have been in hospital, and certain medications that you take (including antibiotics).

These specific infections require the use of special antibiotics and, at times, special precautions which may include placement in a single room and the use of personal protective equipment such as gloves and gowns.

What are Healthscope hospitals doing to prevent infections?

Specialised Infection Control teams collect data on hospital acquired infections and analyse the data to identify patterns and trends. Infection rates are shared and discussed with clinicians in an effort to identify and implement the best practices to reduce the risks for infection.

There are several types of infections that we closely monitor at Healthscope hospitals. Both are caused by bacteria. You may have heard of these:

Clostridium difficile – this is an infection of the bowel that causes diarrhoea.
Staphylococcus aureus bacteraemia – known as “SAB” for short. This is a serious infection caused when this bacteria enters the blood stream.

This graph shows the number of Staphylococcus aureus infections in Healthscope hospitals for the year ending June 2011 compared with the Australian Government target. The graph shows the number of infections that occur for every 10,000 patient days. The national benchmark for Staphylococcus aureus Bacteraemia in Australian public hospitals is no more than 2 cases per 10,000 patient days. Patients in Healthscope hospitals on average have a very low number of infections.

This graph shows the number of Clostridium Difficile infections in Healthscope hospitals compared with the rate typical in other hospitals in Australia. Rates of infection typically vary from state to state. The rate varies from 2 to 3 cases per 10,000 days of patient care, so the industry rate reflects this range. The graph shows the number of infections that occur for every 10,000 patient days. Patients in Healthscope hospitals on average have a very low number of infections.

To find out how we generated this data, see: Infection Rate Formulas

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to further reduce infections

Improvement strategies may vary from hospital to hospital. Examples are:

Watching, auditing and measuring how often staff wash their hands using soap and water or hand sanitiser.
Routine use of gloves and specially sterilised equipment.
An Infection Control Nursein each hospital, to investigate issues, educate staff and carry out strategies to reduce infections.
Use of specialised approved disinfectants for cleaning and disinfecting rooms, bathrooms, equipment and shared areas. High level disinfection and sterilisation are used according to national guidelines.
Placement of hand sanitiser dispensers in public areas throughout our hospitals including hallways, elevators and cafeterias, making this readily accessible to staff, patients, families and visitors.
If additional precautions are required, staff may wear gloves, gowns, masks and goggles.

How can you help?

At Healthscope, patients and visitors are part of the health care team. Hand washing is the most important way that patients and visitors can prevent the spread of infection in hospital. Waterless hand sanitiser is just as effective as washing with soap and water. Hospital staff will appreciate a reminder from patients or relatives if they forget to wash their hands.

There are a number of things you can do to reduce the risk of infection:

Wash your hands carefully with soap and water or use hand sanitiser upon entering the hospital
Cover your mouth and nose with a tissue when you cough or sneeze (or into your elbow if you don't have one). Clean your hands afterwards – every time!
Report any infection you have had, especially if you are still on antibiotics
Make sure you take the full course of antibiotics you have been given, even if you are feeling better
If you have a dressing or a wound, keep the skin around the dressing clean and dry. Let the healthcare worker looking after you know promptly if it becomes loose or wet
Tell the healthcare worker looking after you if the area around the drips, lines, tubes or drains inserted into your body becomes red swollen or painful.
Let the healthcare worker looking after you know if your room or equipment hasn't been cleaned properly
Stop smoking before any surgery, as smoking increases the risk of infection.

Visitors

Reconsider your visit if you have an illness such as a cough, cold or gastroenteritis
Wash your hands carefully with soap and water or use hand sanitiser when entering and leaving a patient’s room.

For more information about how you can help:

Read: Hand Hygiene Information Leaflet

Watch: Interactive Video Training

Link to: Better Health Channel

Patient Falls

Patients are often in a weakened or confused state in hospital, and are more susceptible to falling. Falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. At Healthscope hospitals we document and investigate every fall and take action to reduce the number of falls that occur.

This graph shows the number of falls in Healthscope hospitals for the past 3 years, compared with the rate typical in other hospitals from Australia, the UK and the USA. Falls are presented as a percentage of patient days – allowing us to compare Healthscope hospitals with other hospitals of a different size. Patients in Healthscope hospitals on average have a lower rate of falls than those in other hospitals.

See details on: How we work out our falls rate

For a discussion on the data, see: Limitations of data

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to further reduce falls

Reducing the risk of patient harm resulting from falls is one of the patient safety goals of the Australian Commission on Safety & Quality in Healthcare (ACSQHC) . Healthscope has a falls-reduction program that provides guidelines for everyone involved in the care of patients in all of our hospitals. The falls-reduction program includes patient evaluation, interventions, staff education and training, patient education and outcomes assessment.

Improvement strategies may vary from hospital to hospital. Examples are:

Assessment of all patients for risk of falls
Implementation of precautions to reduce the risk of falling for example:
- Non-slip socks
- Bed and chair sensors which detect patient moving from bed
- Use of lifting equipment and walking aids
Analysis of falls incidents
Spot audits to provide information about environmental factors
Use of a “traffic light” system where patients are given a red, orange or green tag, which alerts staff to whether the patient is at risk of falling

How can you help?

At Healthscope, you, as a patient or visitor are part of the health care team. Print a brochure containing handy hints about preventing falls in hospital and at home. You can also watch a helpful video.

Brochures

Video

Speak Up Reduce Your Risk of Falling

Emergency Department Waiting Times

When a patient visits an Emergency Department, anywhere in Australia or New Zealand, the triage nurse carries out an assessment of how urgent the patient’s condition is. Each patient is assigned a triage category from 1 to 5 on the Australasian Triage Scale . According to the best practice guidelines, patients must be seen for medical assessment and treatment within the following times:

Category 1 patients must be attended to immediately (e.g., cardiac arrest)
Category 2 patients attended to within 10 minutes (e.g., severe blood loss)
Category 3 patients attended to within 30 minutes (e.g., head injury but conscious)
Category 4 patients attended to within 60 minutes (e.g., sprained ankle, possible fracture)
Category 5 patients attended to within 120 minutes (e.g., cut not requiring stitches)

Patients that are category 1, 2 or 3 will be seen before category 4 and 5, even if they arrive in the department at a later time. If you visit an Emergency Department you can ask the triage nurse what category you have been assigned and this may give you an idea of how long you may be expected to wait.

All hospitals with Emergency Departments measure how quickly patients are seen in the Emergency Department. The graphs below show the percentage of patients in each Category that are seen within the recommended time at Healthscope hospitals. On average, patients visiting Emergency Departments at Healthscope hospitals are seen more quickly than in other Australian hospitals.

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to improve our emergency response times

Improvement strategies may vary from hospital to hospital. Examples are:

Continually reviewing our doctor and nurse staffing levels
Monitoring the number of ambulance presentations to our Emergency Departments
Monitoring bed availability for transfers to the ward

Unplanned Readmission to Hospital

After a successful hospital stay, the most important task for patients, families and staff is preparing for a successful discharge home. It is disappointing for everyone if a patient requires an unexpected readmission into hospital.

Tracking the number of patients who experience unplanned readmissions to a hospital after a previous hospital stay is one way that we can judge the quality of hospital care. One example of an unplanned readmission would be someone who is readmitted to the hospital for a surgical wound infection that occurred after his or her initial hospital stay.

It is important to note that unplanned hospital readmissions may or may not be related to the previous visit, and some unplanned readmissions are not preventable. Good discharge plans can help reduce the rate of unplanned readmissions by giving patients the care instructions they need after a hospital stay and by helping patients recognise symptoms that may require immediate medical attention.

This graph shows the percentage of patients admitted to Healthscope hospitals that have required an unexpected and unplanned readmission to hospital within 28 days of their first admission. The rate for the past 2 years is shown in the blue bars. This is compared to the rate of “unplanned readmission” in other Australian hospitals (the grey bar).

The graph shows that patients admitted to Healthscope hospitals are less likely to have an unplanned readmission compared with other Australian hospitals.

There is a limitation to this data. Currently no unique patient identifier exists that would allow us to measure unplanned readmissions to a different hospital. Therefore the unplanned readmission rates presented in this graph represent patients re-admitted to the same hospital only.

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to further reduce unplanned readmission rates

Improvement strategies may vary from hospital to hospital. Examples are:

We review each case of re-admission to check if there were any preventable factors
Check each patient’s risk for readmission
Use a consistent process for discharging patients that includes making sure patients understand their medications and other instructions
Arranging prompt follow up care and ongoing appointments, e.g. with Physiotherapist and General Practitioner
We monitor this data to make sure that the rate of unplanned readmission is not increasing

Unplanned Return to Theatre

Most Healthscope Hospitals have an operating theatre and carry out many sessions of surgery every year. One of the ways of monitoring the success of surgery is to check whether any patients require an unexpected second operation – we call this “return to theatre”. There are many reasons why a patient may need a further operation – however where possible we aim to minimise this number.

This graph shows the percentage of patients having an operation or procedure at Healthscope hospitals that have required a return to theatre during the same admission. The rate for the past 2 years is shown in the blue bars. This is compared to the rate of “return to theatre” in other Australian hospitals (the grey bar). The graph shows that patients undergoing surgery in Healthscope hospitals are less likely to have an unexpected return to theatre compared with other Australian hospitals .

To view data for each Healthscope hospital, see: Healthscope Hospitals

What we are doing to reduce unplanned returns to theatre

Improvement strategies may vary from hospital to hospital. Examples are:

Careful monitoring of patients in recovery
Ensuring patient’s level of pain is carefully assessed
Reviewing every case when a patient requires a return to theatre, to work out the reasons why and how to prevent it in future
Conducting thorough pre-operative evaluation including coagulation studies and anti-coagulant therapy management where indicated
Pre-admission assessment of high risk patients to make sure all required tests and precautions are taken

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Healthscope Hospitals Medical Centres GP Clinics Skin Clinics Community Programs Human Pathology Advanced Pathology Veterinary Pathology Australia New Zealand Commercial Pathology Functional Pathology	Accreditation, Quality & Safety Measures of Hospital Performance At Healthscope, we take quality and safety seriously. To help patients make informed decisions, Healthscope publishes indicators which reflect the quality and safety of its network of 44 hospitals. Healthscope is proud to be the first private hospital group in Australia to publish the results of its clinical performance and health outcomes on its website. This is just one part of our program to continually maintain and improve our high standards of quality and safety. Quality can be defined and measured in many ways. At Healthscope, quality is not just a simple measure – it is a comprehensive look at many aspects of a patient's experience. We have chosen to publish a range of clinical and safety measures which provide you with information about our performance in providing safe, quality healthcare. Click on the links below to view Healthscope data averaged across our 44 hospitals. Accreditation Rehabilitation Health Outcomes Infection Rates Patient Falls Emergency Department Waiting Times Unplanned Readmission to Hospital Unplanned Return to Theatre To view data for each Healthscope hospital, see: Healthscope Hospitals Many organisations today are measuring quality in health care using varying criteria. Evaluating this information can be difficult and time-consuming since not all measures reflect the same information from one report to another. However, it is important for patients to ask questions and look at quality information to ensure they are getting the efficient and effective care they need. Healthscope supports transparent public reporting of healthcare quality data and actively participates in initiatives of the following organisations. Australian Commission on Safety and Quality in Healthcare (ACSQHC) – The Australian Commission on Safety and Quality in Healthcare (the Commission) was established in 2006 by the Australian, State and Territory Governments to lead and coordinate national improvement in safety and quality. Healthscope has representation on the Private Hospital Sector Advisory Committee and several key working groups. Australian Institute of Health and Welfare - The Australian Institute of Health and Welfare (AIHW) is a major national agency set up by the Australian Government under the Australian Institute of Health and Welfare Act to provide reliable, regular and relevant information and statistics on Australia's health and welfare. MyHospitals Website – This website lists all public and private hospitals in Australia, along with information about waiting times for elective surgery and emergency department access. Healthscope has representation on the MyHospitals Development Advisory Committee. If you would like more information about the pros and cons of public reporting, see: Public Reporting Literature Patient Stories The experiences of our patients are another gauge of how well we are doing at caring for patients and their families. To have a look at what they say, see: Patient Stories Back to top Accreditation All Healthscope hospitals are fully accredited against one of two accreditation schemes accepted by the Australian Government. Accreditation is conducted against either the Australian Council on Health Care Standards (ACHS), Evaluation and Quality Improvement standards (EQuIP) or ISO 9001 standards. Accreditation involves a visit to the hospital from an independent team of expert health professionals who review the quality and safety of services provided. Our achievements are measured against industry standards by this review team. Hospitals are measured against many different criteria including patient care planning, medication management, the consent process, medical records, infection control, complaints management and staffing. Hospitals receive a rating for each one of these criteria. For hospitals accredited by ACHS, a higher level of award is sometimes given – this is referred to as “EA” or “extensive achievement”. This chart shows the proportion of “EA” ratings achieved by Healthscope hospitals for the most recent accreditation surveys conducted, in comparison with other Australian hospitals . Healthscope hospitals have achieved a higher proportion of EA ratings than other hospitals. To view data for each Healthscope hospital, see: Healthscope Hospitals Healthscope corporate office is also accredited by ACHS using the EQuIP Corporate Program. This accreditation looks at how well we run our 44 hospitals, and measures the entire organisation against criteria such as risk management, occupational health & safety, human resources, quality improvement, IT service delivery and consumer involvement. The graph shows that the corporate office achieved a very high proportion of EA ratings (12 out of 29) at the most recent accreditation survey (Organisation Wide) in November 2010. Other Awards Healthscope is proud of the recognitions of excellence bestowed on its hospitals and staff. Examples of recent awards are: Knox Private Hospital (VIC) awarded 2010 Victoria and Tasmania Employer Award. Brisbane Waters Private Hospital (NSW) awarded for Community Partnership receiving the 2011 Industry Partnership Award from Hunter TAFE. National Capital Private Hospital (ACT) awarded the Best Workplace Health and Safety Management System in the Private Sector for the ACT for 2010. National Capital Private Hospital (ACT) was awarded Outstanding Achievement at their accreditation in 2010 for Care and Services that are planed, developed and delivered based on the best available evidence and in the most effective way – in particular relationship to work and achievements in VTE prevention.Broadwater Dunsborough Medical Centres group (WA) was awarded the Royal Australian College of General Practitioners (RACGP) West Australian Practice of the Year Award 2010. Knox Private Hospital (VIC) awarded an Outstanding Achievement at their accreditation survey in 2009 for Infection Control and Sterilisation procedures. The Geelong Clinic (VIC) awarded Outstanding Achievement at their accreditation survey in 2009 for research and the integration of research findings in the treatment of depression and other mental illnesses. Research led by Professor Michael Berk. The Melbourne Clinic (VIC) was a finalist in the 2010 EOWA Business Achievement Awards for Outstanding Workplace Flexibility Achieved through Job Design for an innovative evening program designed by Day program Manager, Lily Shatkin. The Melbourne Clinic (VIC) in 2009 won an Equal Opportunity Award for innovative and flexible working conditions for women. Ashford Hospital (SA) nurse, Shani Dean was awarded South Australia's Midwife of the Year 2009. Clinical neuropsychologist, Dr Wayne Reid, at Brisbane Waters Private Hospital and The Sydney Clinic (NSW) won the prestigious Cornelli Award 2009 for his work researching Parkinson's Disease and Dementia. His study was a twenty-year neuropsychological study which showed increasing age is an important factor in determining the prognosis in Parkinson's disease. Jacqueline McDonald - Mount Hospital (WA) was a finalist in the WA Enrolled Nurse of the Year Awards 2008. She designed a hand splint used in shoulder arthroscopies in Australia and overseas. It’s known as the "McDonald Splint". Prince of Wales Private Hospital (NSW) midwife Anne Carter received the Midwife of the Year award 2008 from among 1100 nominations in NSW. The Australian College of Midwives Executive Officer said the award gives patients the opportunity to extend their own personal thanks to the midwives who had a positive impact on their family's life. Prince of Wales Private Hospital (NSW) Bookings and Beyond Project was the winner of the 2009 Healthscope Service Excellence Recognition Awards in the quality improvement category. RN Maureen Eddison, Prince of Wales Private Hospital (NSW) winner of the Healthscope Service Excellence Recognition Awards 2010 individual award category for team work. Ringwood Private Hospital (VIC) was awarded the state and national award of the year in 2009, by Look Good, Feel Better, a community service program dedicated to helping women undergoing cancer treatment to manage the appearance related side effects of chemotherapy and other treatments to restore their self-image and self-esteem. National Capital Private Hospital (ACT) was awarded Outstanding Achievement at their accreditation in 2010 for Care and Services that are planned, developed and delivered based on the best available evidence and in the most effective way – in particular relationship to work and achievements in VTE prevention Back to top Safety and Quality Improvement Programs Healthscope hospitals have a wide range of programs and protocols, which focus on the continuous enhancement of safety and optimal health care for all patients, visitors and employees. Ten Tips for Safer Healthcare Consistent with the Australian Commission on Safety and Quality in Health Care (ACSQHC), Healthscope recognises the potential for enhanced safety by engaging our patients in a safety partnership. The Commission has produced a fact sheet designed to assist patients in hospital to become more actively involved in their own health care. It explains how things can go wrong and provides tips for improving patients’ health care. It provides an outline of the kind of information that can reasonably be expected from the patient’s health care professional, how to find out more about the patient’s condition, how to manage medication and what to do if patients have concerns about their health care. For further details on this health care fact sheet, see: 10 Tips for Safer Healthcare WHO Surgical Safety Checklist and Timeout Process At Healthscope hospitals where surgery and procedures are performed, we follow the Royal Australian College of Surgeons’ Implementation Guidelines for ensuring correct patient, correct side and correct site surgery as well as the WHO Guidelines for Safe Surgery 2009. The protocol involves the use of a Surgical Safety Checklist and a surgical team “Time Out” for patient verification, confirmation of the procedure, the procedure side and site, patient allergy status and other key elements of a safe surgery. Venous Thromboembolism (VTE) Prevention VTE is a blood clot in the veins or lungs that can be a complication of hospital treatment. Healthscope hospitals use the guidelines published in the “Prevention of Venous Thromboembolism: Best Practice Guidelines for Australia and New Zealand 5th Edition October 2010”. The guidelines recommend treatment for patients at risk of VTE. The extent of treatment is dependent on the patient’s clinical risk factors. VTE prophylaxis (preventative measures) occur in consultation with the patient’s doctor and may include: Mechanical graduated compression stockings (GCS) or intermittent pneumatic compression (IPC) devices including foot pumps. Pharmacological prophylaxis (drugs to reduce the risk of VTE), for example, low dose unfractionated heparin (UFH) or low molecular weight heparin (LMWH) National Inpatient Medication Chart The National Inpatient Medication Chart (NIMC) is a major initiative of The Australian Commission on Safety and Quality in Health Care (ACSQHC). The NIMC is designed to improve the safe use of medicines through the standardisation of medication ordering in hospitals, with a common medication chart in use at all public and private hospitals in Australia. In its summary rationale for a national medication chart”, The ACSQHC explains that ensuring a hospital patient receives the best therapy in a safe, accurate manner is a complex process involving many health professionals including doctors, pharmacists and nurses. A critical element of this process is the communication of the prescription. Evidence suggests this communication can be made safer if the process is standardised and made with a better understanding of safety principles. For example if a nurse or doctor works in both a public and a private hospital, the medication charts used in both settings will be very similar. The clinicians’ familiarity with the layout of the medication chart helps to reduce inadvertent errors. The use of the National Inpatient Medication Chart has proven to reduce the risk of medication errors. Twenty Healthscope hospitals are participating in an audit of the National Inpatient Medication Chart run by the Australian Commission on Safety & Quality in Healthcare. This will help to ensure that the chart is being used correctly and safely for every patient. Obstetric Care All hospitals that have obstetric care dial into a regular teleconference to discuss improvements and best practice. A specialised e-learning training package has been introduced to ensure that nursing staff are up to date with the latest practice in areas such as Electronic Foetal Monitoring, Shoulder Dystocia, Newborn Care and Post Partum Haemorrhage. Blood Transfusion Our hospitals have policies and procedures in place to make sure blood transfusions are managed smoothly. Our policies are referenced to the latest guidelines and documents from the National Blood Authority (NBA), National Health & Medical Research Council (NHMRC) and Australasian Society of Blood Transfusion (ASBT). Nursing staff involved in blood transfusions have completed an e-learning “Bloodsafe” training package. We regularly liaise with the Australian Red Cross Blood Service to ensure that our practices are consistent and comply with all requirements. The National Transfusion Committee addresses any issues arising and ensures that hospitals and pathology services work well together. Patient Centred Care All hospitals conduct patient surveys each quarter and results of these are compared from site to site to make sure any issues are addressed. Healthscope has trialed a new project in 6 of our hospitals during 2010/11 that has involved specific customer service and patient-centred care education programs for nursing staff, and introduction of patient-centred care strategies (such as bedside handover). The patients were then surveyed again to find out about their experience in hospital. The project has shown good results and is currently being rolled out to all hospitals. X-ray and Diagnostic Imaging Healthscope have achieved Diagnostic Imaging accreditation (2nd stage) for 34 hospital-based and 4 stand-alone diagnostic imaging services. All services are currently accredited until 2015 and we were the first major hospital group to achieve the 2nd stage accreditation. Back to top Rehabilitation Health Outcomes Patient abilities, mobility and independence are measured on admission to our hospitals and again on discharge so that we can measure the improvement made. Patients demonstrate improvement in their abilities, mobility and independence after treatment at Healthscope hospitals. We use the FIM™ (Functional Independence Measure) to measure the success of rehabilitation. This is an established scale, used worldwide. Improvement in patient abilities will depend on factors such as patient age, severity of condition on admission and other medical problems such as diabetes or dementia. For example if a hospital has a high number of patients over the age of 75 years, compared with other hospitals, the patient abilities may not improve so much. Orthopaedic Fracture Rehabilitation This graph shows the average improvement in patients at Healthscope Hospitals following rehabilitation after a broken bone. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals. Rehabilitation for Hip, Knee or Shoulder Replacement This graph shows the average improvement in patients at Healthscope Hospitals following rehabilitation after a hip, knee or shoulder replacement. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals. Stroke Rehabilitation This graph shows the average improvement in patients after stroke rehabilitation at Healthscope Hospitals. The dark coloured bar shows patient abilities on admission and the pale coloured bar shows that these abilities have improved on discharge. Rehabilitation patients at Healthscope hospitals achieve outcomes similar to those of patients in other Australian private hospitals. To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to continually improve our patients’ rehabilitation Improvement strategies may vary from hospital to hospital. Examples are: Individual and group therapy – individualised therapy time which may include practising tasks of daily living Multi-disciplinary team assesses and works with patient to set and meet goals Use of Functional Electrical Stimulation (FES) to improve strength and function in stroke patients Depression screening for all stroke patients (if depressed not able to participate fully in rehabilitation) Swallowing and speech/language therapy by Speech Pathologists Back to top Infection Rates All Healthscope hospitals have infection control procedures, and staff take every precaution to prevent infections. However, some patients have a higher risk of acquiring an infection in hospital. Patients with wounds, invasive devices (such as drips) and weakened immune systems are at greater risk of infection than the general public. We need to avoid infections because they may cause illness to the patient, resulting in a longer stay in hospital and a longer recovery time. What are Healthcare Associated Infections? Healthcare associated infections (HAI) are infections that occur as a result of healthcare interventions and are caused by micro-organisms such as bacteria and viruses. They can happen when you are being treated in hospital, at home, in a GP Clinic, a nursing home or any other healthcare facility. Some infections occur after an invasive procedure such as surgery and can be treated with antibiotics. However there are some infections such as Methicillin Resistant Staphylococcus aureus (MRSA) and Clostridium Difficile that are more difficult to treat because they are resistant to certain antibiotics. The risk of getting these infections depends on how healthy you are, how long you have been in hospital, and certain medications that you take (including antibiotics). These specific infections require the use of special antibiotics and, at times, special precautions which may include placement in a single room and the use of personal protective equipment such as gloves and gowns. What are Healthscope hospitals doing to prevent infections? Specialised Infection Control teams collect data on hospital acquired infections and analyse the data to identify patterns and trends. Infection rates are shared and discussed with clinicians in an effort to identify and implement the best practices to reduce the risks for infection. There are several types of infections that we closely monitor at Healthscope hospitals. Both are caused by bacteria. You may have heard of these: Clostridium difficile – this is an infection of the bowel that causes diarrhoea. Staphylococcus aureus bacteraemia – known as “SAB” for short. This is a serious infection caused when this bacteria enters the blood stream. This graph shows the number of Staphylococcus aureus infections in Healthscope hospitals for the year ending June 2011 compared with the Australian Government target. The graph shows the number of infections that occur for every 10,000 patient days. The national benchmark for Staphylococcus aureus Bacteraemia in Australian public hospitals is no more than 2 cases per 10,000 patient days. Patients in Healthscope hospitals on average have a very low number of infections. This graph shows the number of Clostridium Difficile infections in Healthscope hospitals compared with the rate typical in other hospitals in Australia. Rates of infection typically vary from state to state. The rate varies from 2 to 3 cases per 10,000 days of patient care, so the industry rate reflects this range. The graph shows the number of infections that occur for every 10,000 patient days. Patients in Healthscope hospitals on average have a very low number of infections. To find out how we generated this data, see: Infection Rate Formulas To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to further reduce infections Improvement strategies may vary from hospital to hospital. Examples are: Watching, auditing and measuring how often staff wash their hands using soap and water or hand sanitiser. Routine use of gloves and specially sterilised equipment. An Infection Control Nursein each hospital, to investigate issues, educate staff and carry out strategies to reduce infections. Use of specialised approved disinfectants for cleaning and disinfecting rooms, bathrooms, equipment and shared areas. High level disinfection and sterilisation are used according to national guidelines. Placement of hand sanitiser dispensers in public areas throughout our hospitals including hallways, elevators and cafeterias, making this readily accessible to staff, patients, families and visitors. If additional precautions are required, staff may wear gloves, gowns, masks and goggles. How can you help? At Healthscope, patients and visitors are part of the health care team. Hand washing is the most important way that patients and visitors can prevent the spread of infection in hospital. Waterless hand sanitiser is just as effective as washing with soap and water. Hospital staff will appreciate a reminder from patients or relatives if they forget to wash their hands. There are a number of things you can do to reduce the risk of infection: Wash your hands carefully with soap and water or use hand sanitiser upon entering the hospital Cover your mouth and nose with a tissue when you cough or sneeze (or into your elbow if you don't have one). Clean your hands afterwards – every time! Report any infection you have had, especially if you are still on antibiotics Make sure you take the full course of antibiotics you have been given, even if you are feeling better If you have a dressing or a wound, keep the skin around the dressing clean and dry. Let the healthcare worker looking after you know promptly if it becomes loose or wet Tell the healthcare worker looking after you if the area around the drips, lines, tubes or drains inserted into your body becomes red swollen or painful. Let the healthcare worker looking after you know if your room or equipment hasn't been cleaned properly Stop smoking before any surgery, as smoking increases the risk of infection. Visitors Reconsider your visit if you have an illness such as a cough, cold or gastroenteritis Wash your hands carefully with soap and water or use hand sanitiser when entering and leaving a patient’s room. For more information about how you can help: Read: Hand Hygiene Information Leaflet Watch: Interactive Video Training Link to: Better Health Channel Back to top Patient Falls Patients are often in a weakened or confused state in hospital, and are more susceptible to falling. Falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. At Healthscope hospitals we document and investigate every fall and take action to reduce the number of falls that occur. This graph shows the number of falls in Healthscope hospitals for the past 3 years, compared with the rate typical in other hospitals from Australia, the UK and the USA. Falls are presented as a percentage of patient days – allowing us to compare Healthscope hospitals with other hospitals of a different size. Patients in Healthscope hospitals on average have a lower rate of falls than those in other hospitals. See details on: How we work out our falls rate For a discussion on the data, see: Limitations of data To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to further reduce falls Reducing the risk of patient harm resulting from falls is one of the patient safety goals of the Australian Commission on Safety & Quality in Healthcare (ACSQHC) . Healthscope has a falls-reduction program that provides guidelines for everyone involved in the care of patients in all of our hospitals. The falls-reduction program includes patient evaluation, interventions, staff education and training, patient education and outcomes assessment. Improvement strategies may vary from hospital to hospital. Examples are: Assessment of all patients for risk of falls Implementation of precautions to reduce the risk of falling for example: - Non-slip socks - Bed and chair sensors which detect patient moving from bed - Use of lifting equipment and walking aids Analysis of falls incidents Spot audits to provide information about environmental factors Use of a “traffic light” system where patients are given a red, orange or green tag, which alerts staff to whether the patient is at risk of falling How can you help? At Healthscope, you, as a patient or visitor are part of the health care team. Print a brochure containing handy hints about preventing falls in hospital and at home. You can also watch a helpful video. Brochures Preventing Falls in Hospital Preventing Falls at Home Video Speak Up Reduce Your Risk of Falling Back to top Emergency Department Waiting Times When a patient visits an Emergency Department, anywhere in Australia or New Zealand, the triage nurse carries out an assessment of how urgent the patient’s condition is. Each patient is assigned a triage category from 1 to 5 on the Australasian Triage Scale . According to the best practice guidelines, patients must be seen for medical assessment and treatment within the following times: Category 1 patients must be attended to immediately (e.g., cardiac arrest) Category 2 patients attended to within 10 minutes (e.g., severe blood loss) Category 3 patients attended to within 30 minutes (e.g., head injury but conscious) Category 4 patients attended to within 60 minutes (e.g., sprained ankle, possible fracture) Category 5 patients attended to within 120 minutes (e.g., cut not requiring stitches) Patients that are category 1, 2 or 3 will be seen before category 4 and 5, even if they arrive in the department at a later time. If you visit an Emergency Department you can ask the triage nurse what category you have been assigned and this may give you an idea of how long you may be expected to wait. All hospitals with Emergency Departments measure how quickly patients are seen in the Emergency Department. The graphs below show the percentage of patients in each Category that are seen within the recommended time at Healthscope hospitals. On average, patients visiting Emergency Departments at Healthscope hospitals are seen more quickly than in other Australian hospitals. To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to improve our emergency response times Improvement strategies may vary from hospital to hospital. Examples are: Continually reviewing our doctor and nurse staffing levels Monitoring the number of ambulance presentations to our Emergency Departments Monitoring bed availability for transfers to the ward Back to top Unplanned Readmission to Hospital After a successful hospital stay, the most important task for patients, families and staff is preparing for a successful discharge home. It is disappointing for everyone if a patient requires an unexpected readmission into hospital. Tracking the number of patients who experience unplanned readmissions to a hospital after a previous hospital stay is one way that we can judge the quality of hospital care. One example of an unplanned readmission would be someone who is readmitted to the hospital for a surgical wound infection that occurred after his or her initial hospital stay. It is important to note that unplanned hospital readmissions may or may not be related to the previous visit, and some unplanned readmissions are not preventable. Good discharge plans can help reduce the rate of unplanned readmissions by giving patients the care instructions they need after a hospital stay and by helping patients recognise symptoms that may require immediate medical attention. This graph shows the percentage of patients admitted to Healthscope hospitals that have required an unexpected and unplanned readmission to hospital within 28 days of their first admission. The rate for the past 2 years is shown in the blue bars. This is compared to the rate of “unplanned readmission” in other Australian hospitals (the grey bar). The graph shows that patients admitted to Healthscope hospitals are less likely to have an unplanned readmission compared with other Australian hospitals. There is a limitation to this data. Currently no unique patient identifier exists that would allow us to measure unplanned readmissions to a different hospital. Therefore the unplanned readmission rates presented in this graph represent patients re-admitted to the same hospital only. To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to further reduce unplanned readmission rates Improvement strategies may vary from hospital to hospital. Examples are: We review each case of re-admission to check if there were any preventable factors Check each patient’s risk for readmission Use a consistent process for discharging patients that includes making sure patients understand their medications and other instructions Arranging prompt follow up care and ongoing appointments, e.g. with Physiotherapist and General Practitioner We monitor this data to make sure that the rate of unplanned readmission is not increasing Back to top Unplanned Return to Theatre Most Healthscope Hospitals have an operating theatre and carry out many sessions of surgery every year. One of the ways of monitoring the success of surgery is to check whether any patients require an unexpected second operation – we call this “return to theatre”. There are many reasons why a patient may need a further operation – however where possible we aim to minimise this number. This graph shows the percentage of patients having an operation or procedure at Healthscope hospitals that have required a return to theatre during the same admission. The rate for the past 2 years is shown in the blue bars. This is compared to the rate of “return to theatre” in other Australian hospitals (the grey bar). The graph shows that patients undergoing surgery in Healthscope hospitals are less likely to have an unexpected return to theatre compared with other Australian hospitals . To view data for each Healthscope hospital, see: Healthscope Hospitals What we are doing to reduce unplanned returns to theatre Improvement strategies may vary from hospital to hospital. Examples are: Careful monitoring of patients in recovery Ensuring patient’s level of pain is carefully assessed Reviewing every case when a patient requires a return to theatre, to work out the reasons why and how to prevent it in future Conducting thorough pre-operative evaluation including coagulation studies and anti-coagulant therapy management where indicated Pre-admission assessment of high risk patients to make sure all required tests and precautions are taken If you have any feedback or suggestions for improving this website, Contact Us Back to top
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