Reducing Hospital Complications: A Case Study Of Liverpool Hospital

The health Minister is seeking to reduce the complication rates at several principal referral hospitals and asks you to interrogate data on the self-reported experiences of complications among adult admitted patients in Liverpool, Gosford and St George hospitals and interpret it alongside reliable evidence to determine the most effective planning strategies that can be put in place to reduce the rate at each of these hospitals.

Introduction

Hospital reported patient complication refers to the health-related problems that patients develop while undergoing care in the hospital. These complications can be reduced through strategies for clinical risk mitigation. These complications result from care services such as surgeries causing patients to spend a long time in the hospital and also increase the rate of readmission. Hospitals in Australia have had strikingly high rates of hospital complications and have been trying to reduce them with no success. The rates at which the complications occur vary across the different hospitals.

Some hospitals succeed in lowering some complications but fail in others. In order to come up with effective strategies to reduce these complications, data from across different hospitals should be collected and compared. The success of a certain hospital in reducing a certain complication should act as a guide for other hospitals to emulate. Such complications include infection during the time of admission or after, adverse medication reactions, uncontrolled bleeding during the stay in hospital or a short time after discharge from the hospital, x-ray or test complications, surgery complications, bed sore or pressure wounds, blood clots among others. The hospitals set a target to reduce the instance of complications and improve the quality of care in the hospital. The health ministry should be at the forefront to ensure a reduction in the cases of patient-reported hospital complications.

Data

In the study, the first hospital to be explored is Liverpool. In this exploration patient’s variables such as nation of birth, age and preexisting medical condition will be used to collect the data. On the age, the respondent population is stratified into four age groups. The first age group comprises of patients between the age of 18 to 35 followed by 35-54, 55-74 and finally those above the age of 75. According to the country of birth, respondent is categorized as either born in Australia or not born in Australia. The final category is the presence of preexisting medical condition where the respondent either has any of the condition or does not have. The data for both the year 2015 and 2016 were analyzed.

The data showed that in Liverpool hospital, three hundred and eighteen (318) patients responded to the survey for the year 2015 while in 2016 298 patients responded.

Prevalence of Complication in 2015 and 2016 Based on Age in Liverpool Hospital

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016

The graph above indicates the rate at which patient-reported complications based on age group. The rate at which complications were reported for the two different years based on age group can be calculated as follows:

18-34 years

15/100×38=5

35-54 years

19/100×79=15

55-74 years

18/100×105=18

Above 75 years

16/100×76=12

From the calculations above, there were 5 complication reported for the patient in the 18-34 age group. For the 35-54 group there were 15 reported patient complications, 18 complication for 55-74 and 12 for those above the age of 75 years. The total number of complication reported were 50 out of the 298 patients making a total of 17 %.

Prevalence of Complication in 2015 and 2016 Based on Age in Liverpool Hospital

The rate of complications in Liverpool Hospital for the years 2015 and 2016

Age Group in Years	Complications Reported
	2015	2016
18-34	Insufficient response	5
35-54	11	15
55-74	23	18
Above 75	15	12

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016

However, the year 2015 was different from 2016 with the rate of complications rising by one percent from the previous year.

18-34 years there was no sufficient response from the respondents to report.

34-55 years

13/100×87=11

55-74 years

18/100×130=23

Above 75 years

22/100×72=15

The data above indicate the complications for each age group for the year 2015. The total prevalence of complications was 17%.

Data is then stratified according to the presence of a pre-existing chronic medical condition. In the year 2015, 139 out of the total 318 respondents reported having a long-term medical condition while 179 did not have any condition. 21 percent out of the 139(21/100×139=29) had complications, while 16 percent of those who had no long-term condition had complications (16/100×179=28). In 2016 out of 131 patients had long-standing medical conditions 27 (21/100×131) had complications. Moreover, out of the 167 who reported having no preexisting long-term medical condition, 23(14/100×167) reported complications.

The rate of complications in patients with long-term medical conditions and those without any long-term condition in Liverpool Hospital (2015)

Presence of a long-term Medical condition	Figures	Complication Reported
Condition Present	139	29
No Condition Reported	179	28

 Source: Bureau of Health Information: Patient Survey Data for 2015.

The rate of complications in patients with long-term medical conditions and those without any long-term condition in Liverpool Hospital (2016)

Presence of a long-term Medical condition	Figures	Complication Reported
Condition Present	131	27
No Condition Reported	167	23

 Source: Bureau of Health Information: Patient Survey Data for 2016.

Based on the country of birth, 81 out of the 318 respondents in the 2015 survey were born in Australia. 16 percent of the 81(16/100×81=12) patients reported complications. However, 237 of the 318 were born out of Australia and reported 45 (19/100×237) complications cases.  

Complication Rate by Country of Birth (2015)

Presence of complication	Country of Birth
	Australia	Non-Australia
	81	237
Complication reported	12	45
No complication reported	69	192

Source: Bureau of Health Information: Patient Survey Data for 2015.

In the same hospital in 2016, 298 respondents were involved in the survey. 65 out of the 298 were born in Australia while the rest 233 were born outside Australia.  7 (12/100×65) reported having complications while 44 (19/100×233) of the total non-Australian born also reported having complications.

Complication Rate by Country of Birth (2016)

Presence of complication	Country of Birth
	Australia	Non-Australia
	65	233
Complication reported	7	44
No complication reported	58	189

Source: Bureau of Health Information: Patient Survey Data for 2016.

Gosford Hospital Data

In Gosford hospital, the rate of complications for the year 2015 was 17% while in 2016 it was reported as 18%. In 2015, 408 patients participated in the survey as respondents.

Reported complications based on age group in 2015

18-34 years

18/100×32=5

35-54 years

18/100×81=14

55-74 years

17/100×157=26

Above 75 years

14/100×138=19

32 of the respondent were between the age of 18-34, 81 between 35-54, 157 between 55-74 and 138 above the age of 75 years. In the 18-34 age group 5 reported complications. In 35-54 age group 14 reported experiencing complications. On the other hand the 55-74 age group had 157 respondent and only 26 reported experiencing complications. The final category of those above 75 years of age only 19 reported complications.

Reported complications based on age group in 2016

The Rate of Complications in Liverpool Hospital for the Years 2015 and 2016

18-34 years

Insufficient response

35-54 years

20/100×69=13

55-74 years

15/100×150=22

Above 75 years

14/100×159=22

As the calculations above show, in 2016, there 404 respondents of which 26 of the respondent were between the age of 18-34, 69 between 35-54, 150 between 55-74 and 159 above the age of 75 years. In the 18-34 age group, there were insufficient responses from the respondents for reporting. In 35-54 age group, 13 reported experiencing complications. On the other hand the 55-74age group, 22 reported experiencing complications. The final category of those above 75 years of age had 22 respondents reporting that they experienced complications.

Prevalence of Complication in 2015 and 2016 Based on Age in Gosford Hospital

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016

The rate of complications in Gosford Hospital for the years 2015 and 2016

Age Group in Years	Complications Reported
	2015	2016
18-34	5	Very few
35-54	14	13
55-74	26	22
Above 75	19	22

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016

Data is then stratified according to the presence of a pre-existing chronic medical condition. In the year 2015, 226 out of the total 408 respondents reported having a long-term medical condition while 182 did not have any condition. 40 out of the 226 (18/100×226=40) had complications, while 27 of those who had no long-term condition had complications (15/100×182=27).

The rate of complications in patients with long-term medical conditions and those without any long-term condition in Gosford Hospital (2015)

Presence of a long-term Medical condition	Figures	Complication Reported
Condition Present	226	40
No Condition Reported	182	27

  Source: Bureau of Health Information: Patient Survey Data for 2015.

In 2016 out of 232 patients had long-standing medical conditions 51 (22/100×232) had complications. Moreover, out of the 172 who reported having no preexisting long-term medical condition, 22 (13/100×172) experienced complications.

The rate of complications in patients with long-term medical conditions and those without any long-term condition in Gosford Hospital (2016)

Presence of a long-term Medical condition	Figures	Complication Reported
Condition Present	232	51
No Condition Reported	172	22

  Source: Bureau of Health Information: Patient Survey Data for 2016.

According to the nation of birth, 332 out of the 408 respondents in the 2015 survey were born in Australia. 59 out of the 332 (18/100×332=59) patients reported complications. However, 86 of the 408 were born out of Australia and reported 10 (12/100×86) complications cases.  

Complication Rate by Country of Birth (2015)

Presence of complication	Country of Birth
	Australia	Non-Australia
	322	86
Complication reported	57	10
No complication reported	265	76

Source: Bureau of Health Information: Patient Survey Data for 2015.

In the same hospital in 2016, 404 respondents were involved in the survey. 300 out of the 404 were born in Australia while the rest 104 were born outside Australia. 6 (20/100×300) reported having complications while 13 (13/100×104) of the total non-Australian born also reported having complications.

Complication Rate by Country of Birth (2016)

Presence of complication	Country of Birth
	Australia	Non-Australia
	300	104
Complication reported	6	13
No complication reported	294	91

Source: Bureau of Health Information: Patient Survey Data for 2016.

St. Gorge Hospital Data

The rate of complications in St. George Hospital in stood at 17% for both2015 and 2016. In 2015, 362 patients participated in the survey as respondents and in 2016 338 took part in the survey.

Reported Complications Based on Age Group in 2015

18-34 years

20/100×36=7

35-54 years

19/100×82=15

55-74 years

12/100×115=13

Above 75 years

20/100×129=25

36 of the respondent were between the age of 18-34, 82 between 35-54, 115 between 55-74 and 129 above the age of 75 years. In the 18-34 age group 7 reported complications. In 35-54 age group 15 reported experiencing complications. The 55-74 age group had 13 respondents who reported that they experienced complications. In the group of those above 75 years of age 25 experienced complications.

The Rate of Complications in Patients with Long-term Medical Conditions and Those without

Reported Complications Based on Age Group in 2016

18-34 years

26/100×41=10

35-54 years

15/100×66=9

55-74 years

13/100×130=16

Above 75 years

19/100×101=19

As the calculations above show, in 2016, there were 338 respondents of which 41 of the respondent were between the age of 18-34, 66 between 35-54, 130 between 55-74 and 101 above the age of 75 years. In the 18-34 age group, 10 experienced complication. 9 respondents in 35-54 age group, 16 in the 55-74age group and 19 in the group of those above 75 years of age experienced complications. 

Prevalence of Complication in 2015 and 2016 Based on Age in St. George Hospital

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016.

The rate of complications in St. George Hospital for the Years 2015 and 2016

Age Group in Years	Complications Reported
	2015	2016
18-34	7	10
35-54	15	9
55-74	13	16
Above 75	25	19

Source: Bureau of Health Information: Patient Survey Data for 2015 and 2016

On the basis of the presence of a preexisting chronic medical condition, St. George hospital had 169 patients having chronic conditions in the year 2015 and 193 with no condition. 40 out of the 169 (24/100×169=40) had complications, while 23 of those who had no long-term condition had complications (12/100×193=27).

The rate of complications in patients with long-term medical conditions and those without any long-term condition at St. George Hospital (2015)

Presence of long-term Medical condition	Figures	Complication Reported
Condition Present	169	40
No Condition Reported	193	23

  Source: Bureau of Health Information: Patient Survey Data for 2015.

In 2016 out of 151 patients had long-standing medical conditions whereby 31 (21/100×151) out of these had complications. Moreover, out of the 187 who reported having no preexisting long-term medical condition, 26 (14/100×187) experienced complications.

The rate of Complications in Patients with Long-Term Medical Conditions and those without any Long-Term Condition in St. George Hospital (2016)

Presence of a long-term Medical condition	Figures	Complication Reported
Condition Present	151	31
No Condition Reported	187	26

  Source: Bureau of Health Information: Patient Survey Data for 2016.

According to the nation of birth, 338 respondents were involved in the survey in 2015. 189 out of the 338 were born in Australia while the rest 173 were born outside Australia. 35 (19/100×189) reported having complications while 27 (16/100×173) of the total non-Australian born also reported having complications.

Complication Rate by Country of Birth (2015)

Presence of complication	Country of Birth
	Australia	Non-Australia
	154	184
Complication reported	24	31
No complication reported	130	153

Source: Bureau of Health Information: Patient Survey Data for 2015.

In the same hospital in 2016, 154 out of the 362 respondents in the 2015 survey were born in Australia. 24 out of the 154 (16/100×154=24) patients reported complications. However, 184 of the 362 were born out of Australia and reported 31 (17/100×184) complications cases.  

Complication Rate by Country of Birth (2016)

Presence of complication	Country of Birth
	Australia	Non-Australia
	154	184
Complication reported	24	31
No complication reported	130	153

Source: Bureau of Health Information: Patient Survey Data for 2016

Rates of the different complications in St. George Hospital

Data Analysis

The data obtained from the three hospitals for the two years show a trend in the rate at which complications occurred. In the Liverpool hospital, the rate of complications was 18% in the year 2015 and 17% in 2016. On the other hand, in Gosford, the complications rate was 17% in 2015 and 18% in 2016. St. George hospital had complications rates of 17% in both 2015 and 2016. As compared to the average complication data from the New South Wales the rates of complications were high for the three hospitals than the state average since the state average rate of complications was 15% for both 2015 and 2016 (Bureau of Health Information, 2016).

Complication Rate by Country of Birth (2015)

The rate of infectious complications was reported to be high in all the three hospitals for two years time period. The rates of infections ranged from 4% to 7%. Liverpool had the highest rate of infectious complications in 2016 (7% with St. George hospital reporting the lowest rate infections complications in 2016 (4%).  As Mitchell, Shaban, MacBeth, Wood, & Russo, (2017) asserts, Australia has 83,096 cases of hospital-related infections every year (117). According to Mitchell, Shaban, MacBeth, Wood, & Russo, (2017), infection complication is mostly experienced in immunocompromised patients, for example, those on cancer treatment or any kind of transplant (117).

Poor hand hygiene, long hospital stays used of catheters, for example, urinary catheterization, antibiotics overuse, the presence of wounds, for example, surgical wounds can cause infections. Moreover, patients who are admitted to the high-risk areas of the hospital like the High Dependency Unit and Intensive Care Unit are more likely to acquire infections during the hospitalization period or after hospitalization. Catheterization associated infections are very common and have high mortality rates (Nicolle, 2014, p.23).

Surgical complications being the second common type of complications can be attributed to many factors. Complications from surgery include hemorrhagic shock, pulmonary embolism, reactions to the anesthesia medication, deep vein thrombosis and infections. The causes of the complications are varied, according to David (2013), poor communication and among the surgical teams can be attributed to these complications. Secondly, the hospital staff not applying proper teamwork can cause complications in after surgery in patients. As Chung & Kotsis (2012) assert, patient risk factors such as poor immune state or presence or preexisting comorbidities can cause surgery-related complications (1421).

Other complications like the negative reaction to medication given and x-ray or test complications can be attributed to patients factors for example if a patient is reactive to one or more of the components of the drug. Poor communications between the patients and the healthcare staff can also cause such complications. Pressure wounds and bed sores, on the other hand, are as a result of long hospital stay and poor hygiene in the hospital wards.

According to Assareh et al., (2014), the formation of blood clots after surgery can be as a result of poor post-operative care by the surgical team. The patient needs to be taken good care of and instructed accordingly in order to reduce the risk of a post-operative blood clot which can travel to the lungs causing pulmonary embolism (Assareh et al., 2014).

Evidence-Based Solutions

Complications are a common cause of high mortality rate among patients in the Australian hospitals. There is need to develop strategies that are aimed at the incidences of hospital-associated complications. The strategies developed should fit into the context of the hospitals for which they are applied in order to produce positive outcomes in the delivery of care and lower mortality rate. Infections are the most prevalent and they result in increased healthcare cost (Phu et al., 2016).

In order to reduce infection complications, properly devised procedures for infection control are important. These procedures should be devised by a team comprising members from all the local hospitals in order to come up with specific procedures that will be effective for all the local hospitals based on the available resources (Yokoe et al., 2014, p. 455). These procedures can be applicable across the local hospitals because they are created considering the availability of resources in the hospitals to implement them (Office of Disease Prevention and Health Promotion, 2015).   

Secondly, according to Ellingson et al., (2014), there should be hand hygiene training on all the hospital's staff. Patients also should foster hand hygiene to reduce the cases of complications (Fox et al., 2015, 216). There should be enough funds set aside to cater for this (Lo et al., 2014 p. 464). Given the high rate of infectious complications, this strategy can be effective if well implemented since most of the infections especially during hospitalizations are due to poor hand hygiene (Anderson et al., 2014,p. 66). General hospital hygiene for example disinfections and sterilization of equipments used repeatedly on patients like catheters is key (Saint, 2016, 2111).

From the 2015 and 2016 survey, patients reported having had complains concerning their treatment but they did not report them, they then experienced complications. Different patients cited different reasons as to why they did not report (Bureau of Health Information, 2016). According to Ghaferi, and Dimick, (2016), hospitals should foster good communications in order to reduce the rates of complications and mortality rate resulting from these complications. There should be a platform where patients can communicate to the nurse on any complain about the care they are given. Such platforms include the follow-up platforms (David, 2013). Team work in the hospital is also an effective strategy (Boev and Xia, 2015, p.66).

Moreover according to Ferraro (2016) there should be a way in which the surgical team can report any problem that occurred during surgery in order to reduce surgery-associated complication. Complications such as thromboembolism should be reported (Lau & Haut, 2014, p. 189). Often, complications after surgery occur when there is a mishap during the surgery process that the surgical team does not report out of fear (David, 2013). The World Health Organization “surgical safety checklist” can also be used to reduce complications (Lacassie, 2016). It should be implemented and followed for there be positive outcomes (Berry, 2016, P. 647).

Additionally, the patient should be prepared adequately prior to surgery and taken good care after post-surgery (Chung, & Kotsis, 2012, p. 1421).  An Assessment of the patient’s risks factors for infections should be done in order to know which patients are at risk of postoperative complications and those who are not and take an effective step to prevent these complications (Brown, Edwards, Seaton and Buckley, 2017). The strategy can work for the three hospitals given the high rates of surgery complications which can be attributed to poor preoperative assessment and preparations and postoperative care which s one of the leading cause of postoperative complications (Chung, & Kotsis, 2012, p. 1421).   

Conclusion

In conclusion, the hospital reported complications have been reportedly high in Australia. In the three hospitals, Liverpool, St. George and Gosford the rates of these complications have been reported to range from 15% to 18% in the year 2015 and 2016. Therefore, there is a need for effective strategies to be put across in order to address these challenges. All the strategies discussed above are all applicable to the three hospitals considering their situations.

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