Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study

Abstract

ObjectivesTo determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service.DesignObservational quantitative descriptive study.SettingA public hospital maternity service in Victoria, Australia.Data sourcesA public health service; the Victorian state health quality and safety office—Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency.Main outcome measuresNumbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients.ResultsBetween 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r2=0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality.ConclusionWhile clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.

Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality – Learning from a Government-led Initiative

“…4,5 It can predict quality results, service effectiveness and efficiency. 6 It can also effectively reduce patient injury and associated medical cost 7,8 and is emerging as an important measure of improved health outcomes. 7 Actively seeking patient feedback on matters related to patient experience and expectations not only inform service improvement, but also improve patients' trust, thus maximizing the appropriateness of services and the service improvement efforts.…”

“…18 Feedback reported to the central system independent of health service providers can increase patients' confidence in the protection and respect of their confidentiality and ensure the reliability of the data collected, hence maximizing the value of patient participation. 6,19 Using Patient Feedback to Guide Service Improvement…”

Well spotted: but now you need to do something

“…In this issue, Nowotny and colleagues contribute to the emerging knowledge in this area with their retrospective study of which routinely available data may have given early warning of a service failure in a maternity service in Victoria, Australia. 4 To date, most national approaches to using routine data to identify poor quality have concentrated on posthoc analyses of sentinel poor outcomes-typically clusters of deaths from similar diagnoses within hospitals and units. 5 6 Done well, with appropriate statistical sophistication, this can allow relatively quick identification of emerging problems.…”