Health Evaluation and Planning: Hospital Complications Analysis

This report provides a comprehensive analysis of hospital-acquired complications, focusing on the experiences of elderly patients across three hospitals: Liverpool, Gosford, and St. George. The study examines self-reported data, comparing findings with NSW reports to identify key issues such as pressure injuries, falls, medication errors, infections, and post-surgical complications. The report delves into the statistical data from 2015 and 2016 for each hospital, highlighting trends and areas of concern. The analysis considers demographic changes and the increased vulnerability of elderly patients to adverse events during hospital stays. Evidence-based strategies are proposed to manage patient complication rates, including solutions for fall control, medication error reduction, injury prevention, pressure injury management, and the control of hospital-acquired infections. The report underscores the importance of improved healthcare delivery and the need for proactive measures to enhance the quality of life for elderly patients in hospital settings.

Running head: HEALTH EVALUATION AND PLANNING
HEALTH EVALUATION AND PLANNING
Name of the Student
Name of the university
Author’s note

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Executive summary
The hospital acquired complications are also increasing with the increasing consumers for the
health care. The hospital acquired complications therefore consists of the pressure injuries, falls
resulting in bone fractures, the health care associated infections, the post-surgical complications,
the unplanned intensive care unit admission, the infections in the respiratory system, Increased
bleeding in the hospital wards or unwanted blood clots due to the formation of the pressure
ulcers, increased medication errors or adverse drug reactions, errors occurring during the
diagnostic techniques such as the X-ray , MRI and more. This paper mainly focus on the
vulnerable group of the population that is being affected by the complications- the older adults.
In order to improve their hospital experience and their quality of life the health minister asked for
a survey on the self- reported data taken from the three hospitals- the Liverpool, Gosford and St
George hospitals and compare them with the NSW reports. This reports would aid to understand
the probable problems faced in relation to the hospital acquired complications and the best
possible solutions for improving the care delivery for the adults. The paper has also analyzed
each of the findings from the three different hospitals and have done a comparative analysis with
the NSW records.

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Table of Contents
Introduction......................................................................................................................................4
Data..................................................................................................................................................4
Gosford Hospital..........................................................................................................................4
Data of complication all measures in Gosford hospital vs. NSW...............................................4
Liverpool hospital........................................................................................................................6
Data of complication all measures in Liverpool vs. NSW..........................................................6
St George hospital........................................................................................................................7
Data of complication all measures in St. George hospital vs. NSW...........................................7
Analysis...........................................................................................................................................8
Appraisal....................................................................................................................................12
Solutions........................................................................................................................................13
Solution for fall control.............................................................................................................13
Solution for medication error.....................................................................................................13
Solution for injury......................................................................................................................14
Solution for the pressure injury.................................................................................................14
Solution for bleeding in hospital wards in the geriatric patients...............................................14
Solutions for the hospital acquired infections...........................................................................15
Conclusion.....................................................................................................................................15

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Introduction
According to Westbrook et al. (2014) the rate of complications among the popular
referrals hospitals have increased in Australia. According to the Bureau of Health Information
(BHI) of Annual Healthcare of New South Wales (NSW) (2017), NSW performs significantly
better in comparison to other competitor healthcare companies in other parts of Australia.
However, in spite of having an improved statistics in the domain of active cardiac management
and other critical care, the hospital of NSW suffers from high rate of complications especially in
the emergency units. Westbrook et al. (2014) is sated that the high rate of complications is
associated with the length of the hospital stay. The main mode of the hospital complications
among the admitted patients mainly arises from high blood pressure injury, medication errors,
blood clots, accidental falls and bleeding medication error. The following report aims to analyze
the self-reported experiences of hospital complication among the adult group of population in the
hospital of Liverpool, Gosford and St .George hospital. Upon analyzing the information, the
report will aim to plan effective evidence based strategies that can be used in managing adult
admitted patients’ complication rate.
Data
Gosford Hospital
Data of complication all measures in Gosford hospital vs. NSW

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Infection Uncontrolled
bleeding Falls Blood clots Pressure wounds Surgery
0%
1%
2%
3%
4%
5%
6%
7%
Gosford Hospital comparison for 6 complications
2015 2016
Comparison between Gosford Hospital data for the years 2015 and 2016
It is evident from the graph the occurrence of the pressure wounds in both the years had been
same that shows that there was no improvement in the hospital settings. Both uncontrolled
bleeding, infections, post-surgical complications and fall rates have been found to be more in
2016.

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Liverpool hospital
Data of complication all measures in Liverpool vs. NSW

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Infection Uncontrolled
bleeding Falls Blood clots Pressure wounds Surgery
0
1
2
3
4
5
6
7
8
Liverpool hospital comparison for 6 complications
2015 2016
Comparison between Liverpool Hospital data for the years 2015 and 2016
The data shows that occurrence of uncontrolled bleeding and pressure wounds have decreased in
2016, but all the parameters shows increment than 2015, which signifies falling of the health care
standards.
St George hospital
Data of complication all measures in St. George hospital vs. NSW

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Infection Uncontrolled
bleeding Blood clots Falls Pressure wounds Surgery
0
1
2
3
4
5
6
St.George hospital comparison for 6 complications
2015 2016
Comparison between St. George Hospital data for the years 2015 and 2016

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The occurrence of the uncontrolled bleeding and post-surgical complications have showed a
marked decrease in the year 2016 than the previous year. The percentage for the pressure
wounds have shown an increase.
Analysis
Due to the consequence of the demographic changes the hospitals are confronted with an
augmented number of elderly patients, who are at a high risk of adverse events during the
hospital stay. When the elderly people are admitted to the hospital due to the acute health care
events they can become victim of a large number of complications such as slips and falls, the
hospital acquired infections, pressure injuries and complication faced due to the medical errors.
A large number of adverse condition in hospital is caused due to the medication errors or errors
due to the documentation.
In order to understand the complications faced in referral hospitals the patient survey
records of three hospitals have been taken in considerations. The outcome measures that were
taken in to consideration were- the experienced complication during or shortly after the hospital
stay. As per the reports obtained from the patient survey in the Liverpool hospital about 17 % of
the patient have experienced complication during the hospital stay (Healthstats.nsw.gov.au,
2018). . 7 % of the patient have experienced infections during the hospital stay or after the
discharge from the hospital. Medication error has long been considered as a major problem for
the mortality and the morbidity of the elderly patients. About 3% of the elderly patients have
suffered from medication related complications. Post-surgical complications is a common cause
of dissatisfaction among the hospital inpatients. 4% of the patients have been found to

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experience post-surgical complications. 1% of the patients have been found to experience the
pressure wounds and 3 % blood clots.
1% of the patient have experienced a fall during the hospital stay. Fall related injuries are
the most common type of injures experienced by the older people. As per the NSW reports, the
total health care costs associated to fall related injuries was estimated to be $558.5 million and
hence is a real concern for the NSW government (Healthstats.nsw.gov.au, 2018). Pressure would
in the elderly patient is very common in the elder patient and 1 % of the patient have experienced
bedsores and ulcers. Pressure ulcers has been found to be the clinical indicators for measuring
the health care condition of a particular health care settings. Hospital associated blood clots in
patients can occur within 90 days after the hospital admission. Deep vein thrombosis and
pulmonary embolism are hospital associated blood clots that are faced by most of the elderly
people after the surgery. The unwell adults that were admitted to the hospitals are at risk.
On the other hand that overall complications faced during the hospital stay has been
about 12 % in the Gosford hospital. 6 % of the elderly patients have experienced nosocomial
infections during the hospital stay. 3 % of the patients have been found to have experienced
adverse drug reactions during the hospital stay (Healthstats.nsw.gov.au, 2018). On the other hand
17 % of the elderly patients admitted in the St George hospital has been found to have
experienced overall complications during the hospital stay. 4 % of the patients have been found
to cause nosocomial infection and 2 % adverse drug reaction (Healthstats.nsw.gov.au, 2018).
Report of post-surgical complications was found to be almost same for both the Gosford
and the St. George's hospital which is about 3-4 % of the overall experience of the patients. No
such reports of uncontrollable bleeding during the stay has been found to be in the survey of the

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St. George's hospital, although few responses for bleeding has been found in the case of the
Gosford hospital.
As per ((Healthstats.nsw.gov.au, 2018) NSW maintains a high infection control
standards. In spite of all the measures there are about 83,096 HAIs each year in Australia. Out of
which about 71,186 of them are affected by the urinary tract infections, 4902 affected due to the
Clostridium difficile infections, 1962 affected due to respiratory infections, 3946 surgical site
infections and 1100 hospital onset Staphylococcus Aureus bacteremia (Avci et al. 2012). This
data can be supported by the data of three individual hospitals. The HAIs are found to be
occurring due to lack of cleanliness, ineffective precautions taken during the prolonged surgeries,
lack of cleanliness of the invasive devices such as the urinary or the intravenous catheters (Blot
et al. 2014). Pressure injury not only deteriorates the quality of life of the patient but also
contributes to the economic burden. According to Mehta et al. (2014), pressure ulcers can be
viewed as the adverse outcome of a health care condition and indicates towards poor health care
delivery and breaching of the quality care services. Pressure ulcers are mainly caused in elderly
patients due to prolonged period of immobility. Mobilizing patients is one of the important duty
of the health care professionals to immobilize the patients and presence of the pressure ulcers
may indicate towards the lack of professional standards in clinical settings.
Medications plays an important role in the health care and contribute to the
improvements in the health care outcomes if used appropriately and correctly. Since the
medications are so commonly used they have become one of the most common areas of errors
and adverse effects in health outcomes (Blot et al. 2014). Nearly all the patients that gets
admitted in the hospital uses at least one medication in their treatment regimen. The Australian
studies and other international studies have indicated towards the prevalence of the medicine

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related problems which included the adverse drug reactions and the mediation errors. According
to Coleman et al. (2014) medication error has been considered as a failure in the treatment
regimen that lead to potential harm in the patient. Although, medication errors can be lethal to
every kinds of patients but the can be harmful especially for the elderly patients. Medication
error can be caused at the time of the hospital admission, during the writing of the prescriptions,
during the administration of the medicines, in the hospital pharmacy while placing the order,
identifying the wrong patients. Errors can even be caused at the time of the discharge or after the
discharge. Birkmeyer et al. (2012) has identified that most common type of errors that is the
incorrect documentation of the patient's records and the medications at the time of admission, an
incorrect documentation of the patient's dosage of the medications, omission of the correct
therapy, administration of the medicines without its interaction with the other medicines and the
lack of the explanation to the clients about the change of the medications made during their stay
in the hospital and proper education to the patient and the family about the adherence to the
medications (Avci et al. 2012). Hence this is one of the main factor attributing to the
complications faced during the hospital stay. In an observational study the wrong infusion rates
has been found to be responsible for the 95 out of 101 errors (Healthstats.nsw.gov.au, 2018). As
per studies annual cost of the medication have been found to be AU $1.2 billion
(Healthstats.nsw.gov.au, 2018). Transition from one care to the other has been considered as the
point of vulnerability for the medication management. Birkmeyer et al. (2012) have recognized
falls in elderly patients having cognitive disability, stroke and mainly involves falls from
elevated structures such as from beds or involving the slippery surface. Since proper inventions
and surveillance can be helpful in the prevention of the fall the occurrence of the sentinel events
due to fall can be considered as an indicator the appalling standard of the clinical settings.

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According to Sieber and Barnett, (2011) post-operative complications have been found
to be linked with poor surgical outcomes. Delirium has been considered as the most common
types of complications in the elderly patients. Other types of post-surgical complications
includes infections and pain. Post-surgical infections and pain may be an indicator of the poor
health care delivery service Sieber and Barnett (2011). Proper management of the pain includes
the proper application of the pharmacological and non-pharmacological treatment of the pain.
Appraisal
As per the patient survey report of the Liverpool hospital 298 respondents have been
taken into consideration for the survey which is not a very big sample size. Smaller Sample size
can lead to larger standard deviation that becomes largely different from that of the actual results
(Healthstats.nsw.gov.au, 2018) . A smaller sample size can also question the reliability of the
data and high variability that may give rise to bias. The most common kind of bias that can cause
due to smaller sample size is the non-response bias. Again voluntary response bias can be
another disadvantage that can arise due to smaller sample size. The outcome measures were all
appropriates and measurable for the study as all of them are the major complications that are
faced by the elderly people. Therefore all he questions asked were appropriate. The percentage of
the Liverpool hospital can be compared to the NSW report and it is evident that the experienced
complication in the Liverpool hospital is similar to the NSW report, in which 16 % of 28,693
patients has reported to have experienced complications during or shortly after the hospital stay
((Healthstats.nsw.gov.au, 2018). 404 respondents have been taken in to consideration for
conducting the survey out of which 18 % of the people have actually experienced difficulties
during the hospital stay (Healthstats.nsw.gov.au, 2018)
.

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Solutions
Solution for fall control
According to Pfortmueller, Lindner and Exadaktylos (2014), fall is a common accident
among the elderly individuals and is the major source of injury which increases the tenure of
hospitalization. Miake-Lye et al. (2013) is of the opinion that the main intervention for fall
prevention among the elderly group of population must be undertaken as one of the important
patient safety strategies. Miake-Lye et al. (2013) argued in favor of a multicomponent
intervention for the prevention of fall. This multicomponent intervention mainly includes a
multidisciplinary team with a special mention to a occupational therapist who will assist the
patient towards his or her every step in hospital and thereby helping to reduce accidental injuries
arising from sudden slippage of feet (Miake-Lye et al. 2013).
Solution for medication error
Medication error is another leading cause of increase mortality and morbidity rate among
the patients of the diverse patient group. One of the important approaches that must be
undertaken for the reduction of the medication error is the application of advanced technology.
Forni, Chu and Fanikos (2010) is stressed over the installation of the technical advancement like
computerized physician entry, electronic medication administration record (eMAR) and
telemedicine for the reduction of the medication error under emergency and clinical care settings.
All these technological applications will help in the reduction of the human error while
decreasing the workload load over the healthcare professionals via automation. All these benefits
of technology will help in the significant decrease in the medication error, another leading cause
behind complication error under hospital settings (Forni, Chu and Fanikos 2010).

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Solution for injury
For injury prevention, proper technological advancement along with thorough monitoring
of the patients is mandatory. Porter et al. (2014) stressed over the importance of the using real-
time electronic alter in order to improve the detection of the acute injury of the kidney. Moreover
this automated real-time monitoring system will help the healthcare professionals to get
automatic real time access to the patient latest condition and thereby helping to reduce the
chances of injury.
Solution for the pressure injury
According to Coleman et al. (2014) pressure injury can be prevented by immobilizing the
patient frequently to avoid the prolonged pressure, maintaining the skin integrity and the keeping
the patient clean and dry. This indirectly depends upon the professional standards of nursing and
staffing of the health care professionals (Coleman et al. 2014). Furthermore interventions include
the provision of soft pillows under the affected areas for alleviating the pressure and the
symptoms.
Solution for bleeding in hospital wards in the geriatric patients
Hemorrhoids has been considered as the sources of the gastro intestinal bleeding in the
patients. The comorbid bleeding in the patients may include serious illness in elderly people and
has been found as the second most important factor of the prediction of the mortality in the
geriatric patient (Birkmeyer et al. 2012). The prevention strategies initiates with the detection of
the condition that can be done by the help of colonoscopy in patients. Colonoscopy in elderly
patient can give rise to man complications. Efforts should be given to understand the bleeding
source (Birkmeyer et al. 2012)..

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Solutions for the hospital acquired infections
The guidelines for preventing the nosocomial infections includes the detection of the
patient at risk, observing the hand and hygiene while dealing with the patient, following the
standard guidelines for reducing the transmission and strategies for reducing VAP, CAUTI.
Surveillance and monitoring is the primary measure (Mehta et al. 2014). Interventions includes
the promotion of the five moments of the hand and hygiene , wearing of gloves or gowns while
working infectious services, to take precautions against the airborne infections or contact
precautions, avoiding unnecessary interventions, avoiding noninvasive ventilations, providing
with the strategies to mitigate the catheter associated infections (Mehta et al. 2014). There
should be designated infection control team in order to coordinate antibiotic stewardship. There
should be a close connection among the teams. Other recommendations includes the audit,
formulary restriction, optimizing, dosing and the active use of the information technology (Avci
et al. 2012).
Conclusion
Although a considerable work has been done in case of mitigating the complications,
however a major gap still remains and hence a coordinated surveillance programs are required to
mitigate the problem. The intervention program should have a multifaceted approach as that
would help in addressing in each of the different levels of the health care. A robust training and
change in the health care service delivery is required from the grass root level to identify actual
requirements for the change. Furthermore there is a call for the stringent policies guiding the
hospital health care services and delivery.

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