Hospital‐acquired complications: the relative importance of hospital‐ and patient‐related factors

• Published in: Medical journal of Australia 2022-03, Vol.216 (5), p.242-247
• Main Authors: Duke, Graeme J, Moran, John L, Bersten, Andrew D, Bihari, Shailesh, Roodenburg, Owen, Karnon, Jonathan, Hirth, Steven, Hakendorf, Paul, Santamaria, John D
• Format: Article
• Language: English
• Subjects: Adverse events; Analysis of variance; Morbidity; Quality of health care
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/mja2.51375

Objective To quantify the prevalence of hospital‐acquired complications; to determine the relative influence of patient‐ and hospital‐related factors on complication rates. Design, participants Retrospective analysis of administrative data (Integrated South Australian Activity Collection; Victorian Admitted Episodes Dataset) for multiple‐day acute care episodes for adults in public hospitals. Setting Thirty‐eight major public hospitals in South Australia and Victoria, 2015–2018. Main outcome measures Hospital‐acquired complication rates, overall and by complication class, by hospital and hospital type (tertiary referral, major metropolitan service, major regional service); variance in rates (intra‐class correlation coefficient, ICC) at the patient, hospital, and hospital type levels as surrogate measures of their influence on rates. Results Of 1 558 978 public hospital episodes (10 029 918 bed‐days), 151 486 included a total of 214 286 hospital‐acquired complications (9.72 [95% CI, 9.67–9.77] events per 100 episodes; 2.14 [95% CI, 2.13–2.15] events per 100 bed‐days). Complication rates were highest in tertiary referral hospitals (12.7 [95% CI, 12.6–12.8] events per 100 episodes) and for episodes including intensive care components (37.1 [95% CI, 36.7–37.4] events per 100 episodes). For all complication classes, inter‐hospital variation was determined more by patient factors (overall ICC, 0.55; 95% CI, 0.53–0.57) than by hospital factors (ICC, 0.04; 95% CI, 0.02–0.07) or hospital type (ICC, 0.01; 95% CI, 0.001–0.03). Conclusions Hospital‐acquired complications were recorded for 9.7% of hospital episodes, but patient‐related factors played a greater role in determining their prevalence than the treating hospital.