Clinical evaluation of the national hospital-acquired complication programme

Background: The national hospital-acquired complication programme captures complications arising from patient-related and hospital-related factors, but the proportion of the two is unclear. Aim: Health services are encouraged to evaluate data from the national hospital-acquired complications (HAC) programme and identify strategies to mitigate them. Methods: A retrospective chart review compared HAC extracted from administrative data. The setting was a 430-bed university-affiliated metropolitan hospital. Records from 260 participants with, and 462 without, reported HAC from 2619 multi-day stay adults were reviewed. The main outcome measures were prevalence and positive predictive value (PPV) of HAC methodology. Results: No errors of HAC coding or classification were identified. Four hundred and twenty-three HAC events were reported in 260 records; most commonly delirium (n = 57; 13.4%), pneumonia (n = 46; 10.9%), blood stream infection (n = 39; 9.2%), hypoglycaemia (n = 33; 7.8%) and cardiac arrhythmias (n = 33; 7.8%). One hundred and eight (25.5%) ‘HAC’ events in 69 separations (95% confidence interval (CI) = 2.05–3.33 per 100 separations) were false positive, and 43 of 462 (95% CI = 6.72–12.22 per 100 separations) were false negative. Prevalence of total (reported plus missing) HAC was 16.06 (95% CI = 14.02–19.52), reported HAC was 9.93 (95% CI = 8.76–11.21), potentially preventable HAC was 1.68 (95% CI = 1.22–2.26) and healthcare errors was 0.31 (95% CI = 0.13–1.30) per 100 separations. PPV of HAC for true clinical events was 0.74 (0.68–0.79), preventable events 0.18 (0.13–0.23) and healthcare error 0.03 (0.01–0.06). Conclusions: Prevalence of HAC events was higher than expected, but PPV for healthcare errors was low, suggesting provision of care is a less common cause of HAC events than patient factors. HAC may be an indicator of hospital admission complexity rather than HAC.