09 May 2023

Image of Dr Graeme Duke, VAHI Data Analytic Fellow

This year marks the 30th anniversary of the Australasian New Car Assessment Program (ANCAP), a safety monitoring system that drives improvements in vehicle design, encourages customers to purchase safer vehicles, and improves driver/passenger safety.

As a result, modern vehicles are now fitted with numerous internal safety systems - such as antilock braking, driver-alert detection, emergency braking, collision warning and accident restrain systems (air bags) - that continuously monitor vehicle safety.

While your car is operating within safe boundaries these systems are silent and unobtrusive, but not inactive. They only alert the driver or initiate evasive manoeuvres when a significant deviation or safety concern is identified.

Healthcare safety, like vehicle safety, incorporates safety surveillance and monitoring systems at several levels. Somewhat analogous to the ANCAP system, the Australian Council on Healthcare Standards (ACHS) hospital accreditation system aims to drive improvements in healthcare delivery and patient safety. It does this by comparing hospital performance against eight national standards and 148 individual elements, with hospitals that fulfil these standards more likely to be delivering safer healthcare.

Our hospitals also have access to a suite of ‘on-board’ patient safety systems - triage guidelines, risk assessments, procedural checklists, and clinical guidelines - that identify and mitigate risk and initiate ‘rescue’ procedures in the event of system deviation or failure.

Parallel surveillance systems monitor activity, efficiency, and adverse events. These include clinical audits, incident reports, case reviews, clinical registries, patient experience, and benchmark reports such as PRISM, Monitor and Health Round Table. While none of our monitoring systems are perfect or ideal, some are useful (see December and February newsletters).

Like vehicle monitoring systems, hospital monitoring and surveillance operate mostly in the background; at least, until a warning alarm is triggered. Unlike vehicle safety systems, most hospital safety reports require a manual review process - clinical assessment and interpretation. Under the weight of data overload in these reports, important safety messages and their implications for staff and patients can easily be overlooked.

When hospital safety reports appear unremarkable it is tempting to gloss over or ignore them. Those reports with ‘green lights’, indicating an ‘in-control’ health service, attract no further attention. Instead, we are immediately drawn to those red ‘traffic light’ signals that indicate health service failure, demand an explanation and urgent remedial action. In doing so we may lose sight of important system safety signals.

Is my hospital safe? The answer can often be inferred from the unremarkable results of those routine and mundane monitoring and reporting systems. A valid patient safety monitoring report that appears unremarkable should not be ignored. Those apparently unremarkable results of ‘satisfactory’ performance warrant closer inspection.

They provide practical evidence, in some small way, that this hospital is operating safely and within reasonable expectations. Your staff, and the communities they serve, are entitled to be informed of these reassuring safety signals.

Finally, the ‘safe’ hospital is unlikely to be the hospital reporting few adverse events. It is more likely to be the health service that continuously monitors patient safety, frequently reports significant patient outcomes and learns from these results, delegates operational decisions, and adapts to the current circumstances and its environment.

A ‘safe’ health service is constantly searching for improvements in clinical care and its monitoring systems.

Dr Graeme Duke is VAHI’s Data Analytic Fellow, in addition to his roles as Deputy Director, Eastern Health Intensive Care Services in Melbourne, and clinical lead for intensive care research. To get in touch with Graeme about how we can collaborate to use data more effectively, contact [email protected]