Data were sourced from the Health Corporate Network (HCN), WA Department of Health (WA Health) for this study. HCN is WA Health’s corporate shared service centre that provides services to all employees working for WA Health. HCN consists of four main service areas: supply, finance, human resources (RoSTAR) and reporting. With approximately 650 staff, HCN processes up to 6,000 transactions daily for WA Health. HCN identified that to efficiently and effectively manage all transactions they would need to introduce the concept of automated workflows and information
It is a WA Health requirement to notify them of all clinical incidents. As such all clinical incidents within public hospitals are to be notified via the Advanced Incident Management System (AIMS). WA Health’s Clinical Management Policy 2015 is based on the following principles of clinical governance: transparency, accountability, probity/fairness, patient/consumer centred care, open ‘just’ culture, obligation to act, and prioritisation.
To be effective, clinical incident management requires a ‘no blame’ reporting culture. Responsibilities of all staff are to notify clinical incidents, participate in investigations, and implement recommendations. On the other hand, hospitals are required to take immediate action when a clinical incident occurs to ensure the patient receives appropriate treatment and report the clinical incident to AIMS. Also, an initial investigation of the clinical incident is undertaken within 48 hours to identify critical human error and system failures and implement preliminary actions to prevent harm to further patients.
For confidentiality reasons, information from both databases were de-identified after completion of ethical clearance processes. These data represent a unique dataset, extracted specifically for the analyses in this research by specialised custodians. Each patient and nurse in both datasets were allocated a unique ID number which was recorded on the AIMS and RoSTAR form for de-identification purposes. AIMS data is government owned, nonprofit data. According to the Australian Institute of Health and Welfare (AIHW, 2012), the occupancy rate in the three target hospitals was 90- 95% at the time of data collection.
In 2008, the Performance Activity and Quality Division of the Western Australian Department of Health released a new policy called the Sentinel Event reporting policy, which is now the governance system for safety and quality in Western Australia. This policy was used to draft the Western Australian Strategic Plan for Safety and Quality in Health Care 2013–2017.
Incident outcome levels were classified on a scale of 1-8, with the eight nationally endorsed sentinel event categories shown in table 2. An outcome level of 1-2 is defined as a “near miss” resulting in no harm. It is noted that level 1 data was not provided by the Department of Health and there were very few level 2 cases in this study. Outcome Levels 3-8 refer to events of increasing severity that directly affect the patient ranging from no harm (outcome level 3) to significant or severe harm, i.e. permanent disability or death (outcome level 8).
According to the 2008 policy, incidents resulting in an outcome of level 3 to 8 are to be notified to WA Health. The purpose of this protocol is to ensure that data is accessible and available for the purposes of quality improvement and to prevent or reduce future harm to patients, identify and treat hazards before they cause harm, take preventative actions and share lessons learned (The Clinical Incident Management Policy, 2011).
In 2011 the AIMS Policy was modified to require only the mandatory reporting of level 8 clinical incidents, those that resulted in severe patient harm or death. These were a very small percentage of the total incidents and were withheld by the
Department of Health for confidentiality reasons. These cases were directly dealt with by WA Health with a different process to AIMS and as such, this data was not
available to the researcher. Further, no level one records were in the sample because level one incidents were potential (not actual) incidents only.
Table 2
Advanced Incident Management System Outcome Levels Outcome
Level
Description/Example
Level 1 Dangerous state/potential for harm e.g. understaffed ICU, torn floor covering.
Level 2 Intercepted prior to causing harm e.g. wrong medication drawn up but not given, medication allergy identified so medication not given, bed rails not in place.
Level 3 No harm occurred. No change in condition or treatment e.g. harmless medication given to the wrong patient.
Level 4 Minor harm occurred not requiring treatment. Reviewed by a doctor, extra observations or monitoring, minor harm.
Level 5 Moderate harm occurred. Minor diagnostic investigations undertaken (e.g. blood test, x-ray, and urinalysis), minor treatment (e.g. dressings, cold pack, and analgesia), security or emergency services attendance, allied health review.
Level 6 Moderate harm occurred. Diagnostic investigations (e.g. MRI, CT, surgical intervention), cancellation or postponement of treatment, transfer to another area not requiring increased length of stay, treatment with another medication.
Level 7 Significant harm occurred. Increased length of stay, hospital admission, readmission, transfer to ICU, CPR/resuscitation, secure ward management, seclusion, fractured neck of femur, morbidity which continued at discharge.
Level 8 Severe harm occurred. Permanent disability or death
*Note: Extracted from Performance Activity and Quality Division, Western Australian