• Internal Code :
  • Subject Code : NURS5046
  • University : curtin university
  • Subject Name : Nursing

Clinical Safety and Quality

Contents

Introduction

Comparison of Indicators to National Benchmarks

Analysis of the Issues

Recommendations

Conclusion

References

Introduction

This report intends to evaluate the provided case scenario and critically assess the quality of care services offered within the St. Judd Health Care organization. The report would critically assess the quality of the workforce and related care services in relation to the published news report and compare it against the nation quality indicator.

Comparison of Indicators to National Benchmarks

In accordance to the Australian commission on safety and quality in health care, an established set of quality parameters have been approved for the regulation and quality assessment of the care services that are provisioned by health care settings. As per Garnawat et al. (2017), it has been mentioned that measurement and feedback are instrumental in determining the level of quality improvement. It should also be noted in this regard that the Australian commission on safety and quality in healthcare (ASQHS) recommends the use of research data in order to identify the areas respective to the care services for identifying potential weaknesses that require intervening for facilitating improvement (Safetyandquality.gov.au, 2020). The provided case scenario mentions about the St. Judd Health Care organization that has been reported by the news articles to be compromising with quality issues.

In this section, the national quality standards for an Acute Hospital would be discussed. According to Safetyandquality.gov.au (2020), health care is referred to as accessible when it is readily available to the patients at the correct time and at the right place. Access to health care is also dependent on the diverse population care needs and affordability factors. Also, accessibility to health care has also been said to be evaluated on the parameters of patient waiting times, availability of general practitioners as well as bulk-billing rates (Australian Institute of Health and Welfare, 2020). The AIHW over the past decade has increasingly focused on shortening the national median wait time at the emergency.

The national benchmark of patient wait time, within emergency department has been categorised under five levels (Australian Institute of Health and Welfare, 2020). The first category comprises of the critical emergency of resuscitation and in case of resuscitation, the patients are expected to be seen immediately within the emergency unit of hospitals (Safetyandquality.gov.au, 2020). The second category comprises of ‘emergency cases’ that comprises of critical accidents and other adverse events (Safetyandquality.gov.au, 2020). The national benchmark for handling emergency cases has been recommended to be within ten minutes (Safetyandquality.gov.au, 2020).

The third category comprises of ‘urgent cases’ and the recommended time for seeing patients with urgent healthcare need has been recommended to be 30 minutes (Safetyandquality.gov.au, 2020). The next case comprises of patients with ‘semi-urgent’ needs and the recommended wait time for seeing ‘semi-urgent’ patients has been recommended equivalent to 60 minutes (Safetyandquality.gov.au, 2020). The last category comprises of patients with ‘non-urgent’ needs and the recommended time for assessing patients with non-urgent needs within an emergency care unit has been reported to be equivalent to 120 minutes (Safetyandquality.gov.au, 2020). The triage and waiting time for mental health emergency has also been recommended to follow similar patient waiting guidelines (Safetyandquality.gov.au, 2020).

In addition to the national benchmark related to patient wait timing, it is worth mentioning in this regard that the Australian healthcare system does not have a set national benchmark for prevention of hospital acquire infection of reduction of fall episode within the inpatient elderly patients (Safetyandquality.gov.au, 2020; Shalit, 2016). However, relevant quality standard documents and clinical research trials have increasingly focused on constant surveillance and monitoring so as to reduce the episodes of fall within the in-patient senior adults and cessation of the prevalence of healthcare associated infection within the hospital settings (Kredo et al., 2016; Bloomer et al., 2019).

Analysis of the Issues

  • Increased wait time for patients up to 24 hours for a bed while being admitted through the emergency department

One of the key issues that deserves primary attention can be mentioned as the prolong patient-wait time up to 24 hours for a bed, even on being admitted through the emergency department. In the above section, where the national benchmark and hospital quality indicators have been discussed, it has been stated that the maximum wait time for a patient with ‘non-urgent’ healthcare needs via the emergency could be equivalent to 120 minutes. In cases of other emergency care needs, the waiting time is minimal extending only up to 30 minutes. The stretched wait time up to 24 hours is in complete contrast to the national benchmark. It is also important to note in this regard that the national mean of patient wait time at the emergency in Australia was equivalent to 19 minutes (Safetyandquality.gov.au, 2020).

Also, approximately, 77.8% of the acute healthcare organizations and hospitals across Australia had stringently treated patients adhering to the recommended national benchmark (Australian Institute of Health and Welfare, 2020). Therefore, it is integral for the organization SJHC to critically focus on the stretched wait time of the patients so as to improve care quality outcomes and avoid legal consequences on account of violation of the quality standards. It should also be noted in this regard, that the newsletter mentions that the average wait time for mental health patients waiting to get admitted via the emergency is equivalent to 2 days, which is in striking contrast to the national benchmark (Australian Institute of Health and Welfare, 2020).

  • Doubling infection rate and increased rate of elderly falls within inpatient setting

The provided case scenario further reveals that the hospital acquired infection rate within the inpatient care setting has almost doubled in comparison to the other regional healthcare service organizations. Further, it has also been stated that in the recent times, the percentage of falls within the inpatient-elderly have increased considerably. The incidence of medication errors has also increased up to 12% as against 4% in 2017 and 3% in the year 2018. In this regard, it is vital to consider that although; the Australian health care system does not have a national benchmark in terms of recommended controlled HAI rate or fall prevention rate within inpatient settings, the national quality standards stringently focus on monitoring and surveillance (Khalifa, 2019; Anatharama et al., 2016).

In a continuous attempt at stringent monitoring and surveillance, it is expected that patient safety would be prioritized and the overall rate of morbidity and mortality associated with fall and HAI would reduce within the healthcare setting (Anantharama et al., 2016). In comparison to the reduced rate of infection within the regional health settings as informed by the news report, it is essential to adapt effective surveillance and prevention measures such that positive patient outcomes can be propagated by the hospital.

Discussion on The Workforce Indicators

The data provided on the workforce indicators present a comparative three year analysis of the workforce performance and productivity. In relation to the parameter of absenteeism, the reported data for the year 2017 (absenteeism: 8%; worker injury: 1%) and 2018 (absenteeism: 10% and worker injury: 1.5%); the absenteeism and injury rate has significantly increased which is further evidenced by the data (absenteeism: 15%; worker injury: 10%). In addition to the same, it is also worth noting as against the reported turnover rate of 5% in 2017 and 10% in 2018; the turnover rate has increased considerably up to 25%.

Also, the staff vacancy rate has increased to 15% as against. 2.5% in the year 2017 to 7% in the year 2018. Further, the staff establishment percentage of part-time staffing professionals has also increased from 2017 (10%) but has remained same to the year 2018 which is equivalent to 25%. On the basis of the comparative evaluation, it appears that the efficiency and productivity of the workforce has considerably declined. It can further be stated that the

increased employee turnover and excessive patient load is indicative of a stressed and de-motivated workforce (Mitchell et al., 2017). It has further been mentioned that in the recent times, the number of patient complaints has increased which is indicative of poor service quality provision by the hospital. Also, the consumer engagement committee, the clinical risk management committee and the accreditation committee have not met for the previous six months which indicates poor coordination and planning for the accreditation survey and diminished quality of care outcomes.

Recommendations

On the basis of the service quality and workforce indicators evaluation, it can be said that the organization must immediately adapt measures for improving on the quality of service provision. The following recommendations can assist with positive outcome:

  • The organization must consider formation of a risk analyzing committee for conducting an audit on the care quality provision within the inpatient ward, with specific focus on elderly falls. Also, a rigorous audit must also be considered on the investigating the adverse medication error events for analysing the underlying cause of the errors. This would help to identify the cause of the increased percentage of medication error and falls within the elderly such that effective evidence based strategies can be implemented to foster positive outcomes (Mitchell et al., 2017).

  • The organization must consider increasing staffing for the effective distribution of work load in order to foster a positive work culture. Increased staffing would help alleviate work stress which would improve care outcomes (Cho et al., 2017; Wolf, 2020).

  • The organization must adapt measures to impart advanced training and refreshment training courses to nursing professionals that have been identified to commit medication error. This would help to improve service quality of care provision (Cho et al., 2017).

Conclusion

Therefore, in conclusion it can be said that the report has presented a critical analysis of the provided case scenario. It has identified the Australian national healthcare quality standards and the national benchmarks for improved care quality provision. It has also identified the existing issues and has drawn upon the evidence base to make recommendations that can help improve care outcomes for St. Judd Health Care Hospital.

References

Anantharama, N., Rumantir, G., Jomon, B., Ananda-Rajah, M., & Gilbert, A. (2016, June). Understanding Risk Factors of Elderly Inpatient Falls using Contextual Model. In PACIS (p. 21). Retrieved from: https://aisel.aisnet.org/cgi/viewcontent.cgi?article=1024&context=pacis2016

Australian Institute of Health and Welfare (2020). Australia's Health Performance Framework - Australian Institute Of Health And Welfare. [online] Australian Institute of Health and Welfare. Available at: <https://www.aihw.gov.au/reports-data/australias-health-performance/australias-health-performance-framework> [Accessed 30 April 2020].

Bloomer, M. J., Hutchinson, A. M., & Botti, M. (2019). End-of-life care in hospital: an audit of care against Australian national guidelines. Australian Health Review, 43(5), 578-584. Doi: https://doi.org/10.1071/AH18215

Cho, S. H., Song, K. J., Park, I. S., Kim, Y. H., Kim, M. S., Gong, D. H., ... & Ju, Y. S. (2017). Development of staffing levels for nursing personnel to provide inpatients with integrated nursing care. Journal of Korean Academy of Nursing Administration, 23(2), 211-222. Doi: https://doi.org/10.11111/jkana.2017.23.2.211

Garnawat, P., Andamon, M., Wong, J., & Woo, J. (2017). Assessment of indoor environmental quality in Australian healthcare facilities: a review of standards and guidelines. In Healthy Buildings 2017 Europe (pp. 1-6). ISIAQ Healthy Buildings 2017. ISBN: 9788379472321

Khalifa, M. (2019). Improving Patient Safety by Reducing Falls in Hospitals Among the Elderly: A Review of Successful Strategies. Studies in health technology and informatics, 262, 340-343.

Kredo, T., Bernhardsson, S., Machingaidze, S., Young, T., Louw, Q., Ochodo, E., & Grimmer, K. (2016). Guide to clinical practice guidelines: the current state of play. International Journal for Quality in Health Care, 28(1), 122-128. Doi: https://doi.org/10.1093/intqhc/mzv115

Mitchell, B. G., MacBeth, D., Halton, K., Gardner, A., & Hall, L. (2017). Resourcing hospital infection prevention and control units in Australia: A discussion paper. Infection, Disease & Health, 22(2), 83-88. Doi: https://doi.org/10.1016/j.idh.2017.02.001

Safetyandquality.gov.au (2020). Avoidable Hospital Readmissions | Australian Commission On Safety And Quality In Health Care. [online] Safetyandquality.gov.au. Available at: <https://www.safetyandquality.gov.au/our-work/indicators/avoidable-hospital-readmissions> [Accessed 30 April 2020].

Shalit, N. (2016). Healthcare-associated infections in Australia: is it time for national surveillance?. Australian Health Review, 40(4), 475-475. Doi: https://doi.org/10.1071/AH15163

Wolf, L. (2020). How safe staffing can improve emergency nursing: time to cut the Gordian knot. Emergency Nurse, 28(1). Retrieved from: https://journals.rcni.com/emergency-nurse/evidence-and-practice/how-safe-staffing-can-improve-emergency-nursing-time-to-cut-the-gordian-knot-en.2019.e1928/abs

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