Researchers say Australia has spent three decades reforming patient safety but still cannot answer a fundamental question: are patients actually safer than they were in 1995?
More than 30 years after the landmark Quality in Australian Health Care Study transformed the nation’s approach to patient safety, leading health services researchers are calling for a new review.
Writing in the Internal Medicine Journal, Honorary Professor Peter Hibbert, Professor Johanna Westbrook and Professor Jeffrey Braithwaite, all from Macquarie University’s Australian Institute of Health Innovation, said Australia has invested heavily in safety reforms since the original study but lacks robust national evidence on whether those efforts have reduced patient harm.
The original QAHCS, published in 1995, found that 16.6% of hospital admissions were associated with an adverse event, with around half considered preventable.
The findings prompted the federal government to fast-track the report’s release and drove the creation of many of Australia’s modern patient safety institutions, including the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality Health Service Standards.
Despite those reforms, the authors of the viewpoint said Australia has not repeated the large-scale epidemiological study needed to measure progress.
“Without such evidence, healthcare improvement risks continuing without a reliable compass,” they wrote.
The researchers argued that current patient safety data were fragmented and relied heavily on limited measures such as hospital-acquired complications.
“Incident reporting systems, the most common monitoring tool, capture only a small fraction of harmful episodes; one review found that just 7% of adverse events detected by medical record review appeared in incident reports,” they wrote.
“Since QAHCS, only three modest, cross-sectional record review studies of adverse events have been undertaken in Australia – in paediatrics, general practice and paediatric intensive care.
“By contrast, more than 60 such studies have been completed in Europe and North America.
“A second national study is overdue. Repeated calls over the past 30 years have sought to measure safety in Australian healthcare with methodological rigour.”
They cited evidence showing that incident reporting systems captured only a small proportion of adverse events, with one review finding just 7% of events identified through medical record review were also reported through incident reporting systems.
The researchers proposed a second Quality in Australian Health Care Study using the same core methodology as the original study to allow direct comparison across three decades while incorporating modern digital health capabilities.
The proposed study would review medical records from a representative sample of metropolitan, regional and rural hospitals, while expanding beyond hospitals to include primary care.
Unlike the original study, QAHCS2 would combine traditional manual medical record review with electronic trigger tools and automated algorithms made possible by widespread adoption of digital health records.
The researchers also proposed targeted analyses of vulnerable populations, including older Australians, Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse communities.
They say the study would provide policymakers with contemporary benchmarks on the frequency, severity and preventability of patient harm, while allowing Australia to compare its performance with countries including Canada, New Zealand, Ireland, France and the Netherlands, all of which have undertaken similar studies.
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Importantly, the findings could also be used to validate existing national safety measures, including hospital-acquired complications, which increasingly influence hospital funding and performance assessment.
The researchers said Australia had the capability to undertake a study of this scale, pointing to the CareTrack research program, which successfully reviewed more than 10,000 medical records across 388 healthcare facilities to assess adherence to evidence-based care.
“We now need a coalition of committed stakeholders to drive this important initiative forward with the researchers,” they wrote.
They proposed establishing a national coalition involving the Australian Commission on Safety and Quality in Health Care, the Department of Health, Disability and Ageing, the Australian Institute of Health and Welfare, state health departments, Primary Health Networks, medical colleges, consumer organisations and clinical governance experts to oversee the work.
“QAHCS2 would provide policymakers, clinicians and patients with the most comprehensive assessment of safety in Australian healthcare since 1995,” they wrote.
They said the review findings could “guide resource allocation and safety initiatives based on epidemiologically robust data, validate or recalibrate HACs and other safety metrics, provide assurance (or warning) about progress in patient safety and reinforce Australia’s role as a global leader in safety and quality research”.
“Thirty years after QAHCS, we still lack the evidence to say with confidence whether patient care in Australia is safer,” the researchers concluded.
“QAHCS2 would fill this gap, provide essential benchmarking and guide the next generation of reforms. After 31 years, the time to act is now.”