WACHS Annual Report 2018-19: Agency Performance

Delivering value and sustainability

Our vision is to become a world leader in the provision of country health care. To achieve this we aim to maximise the value we deliver to the community and ensure the long-term sustainability of the services we deliver. We are committed to open and transparent performance reporting, a continuous focus on improving efficiency and effectiveness of all services and to improve and deliver the greatest value for the communities we live and work in.

"We aim to maximise the value we deliver to the community and ensure the  long-term sustainability of the services we deliver."

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Financial summary

The total cost of providing health services to rural and regional areas in Western Australia in 2018-19 was $1.866 billion.
Results for 2018–19 against agreed financial targets (based on Budget statements) are presented in Table 3.

Full details of the WA Country Health Service’s financial performance during 2018-19 are provided in the financial statements section of this report.

Table 3: Actual results versus budget targets for WA Country Health Service

 

2018-19 Target
($’000)

2018-19 Actual
($’000)

Variation
+/- ($000)

Explanation of Variance
Key factors

Total cost of services 1,747,941 1,866,183 118,242
  • Expenditure on continuing and new services for which funding had not been included in the initial target but were the subject of budget adjustments throughout the year and at Mid-Year Review.
  • Impact of asset revaluation decrements.
Net cost of services 1,060,947 1,162,654 101,707
  • Expenditure on continuing and new services for which funding had not been included in the initial target but were the subject of budget adjustments throughout the year and at Mid-Year Review.
  • Commonwealth and Other Grants received for services not included in the initial target but were the subject of budget adjustments throughout the year and at Mid-Year Review.
  • Impact of asset revaluation decrements.
Total equity 2,679,174 2,515,457 (163,717)
  • Revised timelines for completion of various capital projects
  • Impact of asset revaluation decrements.

Approved full-time equivalent
staff level (salary associated
with FTE)

8,026.6 8,023.3 (3.3)
  • Expenditure on continuing and new services for which funding had not been included in the initial target but were the subject of budget adjustments throughout the year and at Mid-Year Review.
  • Impact of asset revaluation decrements.

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Summary of key performance indicators

Key performance indicators (KPIs) assist the WA Country Health Service to assess and monitor the extent to which State Government outcomes are being achieved.

  • Effectiveness indicators provide information that aids in the assessment of the extent to which outcomes have been achieved through the resourcing and delivery of services to the community.
  • Efficiency indicators monitor the relationship between the service delivered and the resources used to provide the service.

Key performance indicators also provide a means to communicate to the community how the WA Country Health Service is performing. A summary of the WA Country Health Service key performance indicators’ performance against targets is given in Table 4.

Note: Table 4 should be read in conjunction with detailed information on each key performance indicator found in the disclosure and compliance section of this report starting on page 116. The KPIs are prepared based on the latest available information.

Table 4: Actual results versus KPI targets for WA Country Health Service

Key performance indicatorTargetActual
Outcome 1:   Public Hospital Based Services that Enable Effective Treatment and Restorative Healthcare for Western Australians  
Unplanned hospital readmissions for patients within 28 days for selected surgical procedures  
Knee replacement ≤26.2 37.7
Hip replacement ≤17.2 23.5
Tonsillectomy & Adenoidectomy ≤61.0 86.6
Hysterectomy ≤41.3 87.4
Prostatectomy ≤38.8 44.2
Cataract surgery ≤1.1 3.1
Appendicectomy ≤32.8 50.3
Percentage of elective waitlist patients waiting over boundary for reportable procedures:  
% Category 1 over 30 days 0% 3.8%
% Category 2 over 90 days 0% 3.0%
% Category 2 over 365 days 0% 2.2%
Total 0% 2.3%
Healthcare-associated Staphylococcus aureus bloodstream infections (HA-SABSI) per 10,000 occupied bed-days ≤1.0 0.97
Survival rates for sentinel conditions:
Stroke
0-49 years ≥94.4% 97.5%
50-59 years ≥93.3% 100%
60-69 years ≥92.9% 97.4%
70-79 years ≥90.0% 94.6%
80+ years ≥82.2% 83.8%
Acute Myocardial Infarction (AMI)
0-49 years ≥99.1% 100%
50-59 years ≥98.9% 100%
60-69 years ≥98.0% 98.2%
70-79 years ≥96.3% 97.9%
80+ years ≥91.9% 93.2%
Fractured Neck of Femur (FNOF)
70-79 years ≥98.7% 100%
80+ years ≥95.3% 97.8%
Percentage of patients who discharged against medical advice
a. Aboriginal patients
b. Non-Aboriginal patients
≤0.77%
≤0.77%
4.7%
0.6%
Percentage of live-born term infants with an Apgar score of less than 7 at 5 minutes post delivery ≤1.8% 1.4%
Readmissions to acute specialised mental health inpatient services within 28 days of discharge ≤12% 19.4%
Percentage of post discharge community care within 7 days following discharge from acute specialised mental health inpatient services ≥75% 79.1%
Average admitted cost per weighted activity unit $6,948 $6,342
Average Emergency Department cost per weighted activity unit $7,072 $6,753
Average non-admitted cost per weighted activity unit $7,136 $5,828
Average cost per bed-day in specialised mental health inpatient services $1,630 $1,669
Average cost per treatment day of non-admitted care provided by mental health services $546 $570
Outcome 2: Prevention. Health promotion and aged and continuing care services that help Western Australians to live healthy and safe lives
Response times for emergency air-based patient transport services (Percentage of emergency air-based inter-hospital transfers meeting the state-wide contract target response time for priority 1 calls) ≥80% 81.8%
Percentage of patients who access emergency services at a small rural or remote Western Australian hospital and are subsequently discharged home 92.2% 84.7%
Average cost per bed-day for specialised residential care facilities, flexible care (hostels) and nursing home type residents $294 $538
Average cost per person of delivering population health programs by population health units $228 $291
Cost per trip of patient emergency air-based transport, based on the total accrued costs of these services per the total number of trips $7,244 $7,049
Average cost per trip of Patient Assisted Travel Scheme (PATS) $431 $446
Average cost per rural and remote population (selected small rural hospitals) $369 $455

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Our values in action

Facilitating change to the national Activity Based Funding model

Activity Based Funding is a way of resourcing hospitals where we are funded for the number and mix of patients we treat.

For hospitals funded in this way, such as our larger hospitals and large metropolitan hospitals, the more patients a hospital treats, the more associated funding we receive. Because some patients are more complicated to treat than others, the model is based on principles to takes this in to account. However, as recently as 2017-18, the model provided limited support to recognise the cost challenges associated with providing hospital services in country areas, particularly in areas that are remote or very remote.

WA Country Health Service and the Department of Health’s national Activity Based Funding team worked collaboratively to gather data and document evidence that articulated the clear financial disadvantage faced by country hospitals in Western Australia. This evidence was included in a submission to the Independent Hospital Pricing Authority under the Assessment of Legitimate and Unavoidable Cost Variations Framework, designed to challenge the status quo and drive national change to the funding model toward greater financial equity for hospitals.

As part of the Independent Hospital Pricing Authority’s review of our case, they visited the Kimberley and Pilbara regions to hear first-hand from clinicians on the ground the healthcare and service challenges that are experienced in remote locations. Our business performance and improvement team demonstrated with supporting data, the unique location based costs associated with delivering services in rural and remote areas. 

As a result of this submission, the Independent Hospital Pricing Authority have added several key adjustments to the national Activity Based Funding model that directly reflects the challenges faced by country hospitals in remote and very remote areas. In 2018-19 WA Country Health Service estimated that these adjustments contributed in excess of $36m in additional funding being allocated to country hospitals in remote and very remote areas to support the sustainability of our health services moving forward.

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Improvements towards emergency department access

Emergency departments are specialist multidisciplinary units with expertise in managing acutely unwell patients for their first few hours in hospital. With an increasing demand on emergency departments and health services, it is imperative that health service provision is continually monitored to ensure the effective and efficient delivery of safe high-quality care.

Percentage of emergency department patients seen within recommended times

When patients first enter an emergency department they are assessed by specially trained nursing staff to determine how urgently treatment is required. The aim of this process, known as triage, is to ensure treatment is given in the appropriate time and should prevent adverse conditions arising from deterioration in the patient’s condition.

The triage process and scores are recognised by the Australasian College for Emergency Medicine and are recommended for prioritising those who present to an emergency department. A patient is allocated a triage score between 1 (immediate) and 5 (least urgent) that indicates their treatment acuity. Treatment should commence within the recommended time of the triage category allocated (see Table 5).

Table 5: Triage category, treatment acuity and WA performance targets

Triage CategoryDescriptionTreatment ActivityTarget
1 Immediate life-threatening Immediate (≤2 minutes) 100
2 Imminently life-threatening ≤10 minutes 80
3 Potentially life-threatening or important time-critical treatment or severe pain ≤30 minutes 75
4 Potentially life-serious or situational
urgency or significant complexity
≤60 minutes 70
5 Less urgent ≤120 minutes 70

By measuring this indicator, changes over time can be monitored that assist in managing the demand on emergency department services and the effectiveness of service provision. This in turn can enable the development of improvement strategies that ensure optimal restoration to health for patients.

In 2018-19, the proportion of WA patients in major rural hospital emergency departments who were seen within recommended time was above the minimum benchmarks for four out of five triage categories (see Table 6).

Emergency Department performance is reflective of challenges in rural hospitals to manage increased demand across emergency and admitted care services.

Table 6: Percentage of hospital emergency department patients seen within recommended times by triage category 2018-19

Triage Category2018–19 Performance (%)Target (%)
1 100 100
2 82.7 80
3 73.2 75
4 78.4 70
5 94 70

Percentage of emergency attendances with a triage score of 4 and 5 not admitted

Typically, patients who are clinically assessed as Australasian Triage Score (ATS) 4 and 5 at presentation to an emergency department are attending as lower acuity and are subsequently treated within the emergency department but may not require admission to an inpatient ward.

For a large number of country hospitals, triage 4 and 5 attendances may reflect the availability of primary care services and out-of-hours general practice options in that community. Where these services are unavailable or restrictive, community members may need to attend a rural hospital emergency department or service for treatment.

In 2018-19, the percentage of emergency department attendances triaged as category 4 and 5 and not admitted can be seen in Table 7.

Table 7: Percentage of hospital emergency attendances with a triage score of 4 and 5 not admitted

Triage Category2017–18 (%)2018–19 (%)
4 – Semi Urgent 91.1 91.7
5 – Non-Urgent 97.7 97.8

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Clinical governance and performance

Quality and standards

Robust systems and standards are essential for high quality health care. Independent assessment and testing of these systems and standards is important for assurance and improvement.

Clinical governance describes the system through which health organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. This is achieved by creating an environment where there is transparent responsibility and accountability for maintaining standards and by striving for excellence in clinical care. The WA Country Health Service Clinical Governance Framework, endorsed in early 2018 has now been implemented across all WA Country Health Service regions to ensure that patients receive safe and high quality healthcare and that there are effective organisational safety and quality systems in place to achieve this.

Quality and standards

The Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme provides the national requirements of accreditation processes required of Australian health services. AHSSQA has developed the National Safety and Quality Health Standards (NSQHS) to guide health service organisations and Boards in their responsibility and obligation for clinical governance of their organisation.

Accreditation under the NSQHS Standards and National Standards for Mental Health Services forms part of this assurance. The 2nd edition of the NSQHS standards came into effect 1 January 2019. The Great Southern and Midwest regions were the first public health facilities in Western Australia to complete a rigorous five day assessment against the eight NSQHS Standards and National Standards for Mental Health Services (NSMHS) conducted by the Australian Council on Healthcare Standards (ACHS). Both regions were commended on their commitment and approach to partnering with patients, consumers and their communities in the design and provision of high quality health care and both met all requirements to achieve accreditation.

The ACHS also oversees accreditation under the National Corporate Program 2nd edition for corporate services with oversight of healthcare facilities. Corporate accreditation includes the eight NSQHS Standards and is a comprehensive accreditation and quality improvement program that facilitates alignment between the corporate service and its health facilities. In 2017 WA Country Health Service was the first public health service in Western Australia to achieve corporate accreditation under the NSQHS Standards and will undergo re-assessment in early 2020. The application of the same standards across the organisation promotes high quality and safe care for consumers by ensuring that there are standard practices between our corporate offices and all of our hospitals and community based services.

"Both regions were commended on their commitment and approach to partnering with patients, consumers and their communities in the design and provision of high quality health care."

"The WA Country Health Service is proud of the improvements we continue to make in ensuring safe and high quality care for our patients."

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Learning from clinical incidents

The WA Country Health Service is is committed to the improvements we continue to make in ensuring safe and high quality care for our patients. We strive to provide the very best, high quality consumer-centred care.

In 2018-19 we achieved this for the vast majority of our patients. However, like other health services, despite the very best intentions of our dedicated staff, a small proportion of patients unfortunately experience poor outcomes which is contributed to by the care they receive.

We are committed to providing an open and transparent environment that supports and encourages our staff to report incidents in the event that something does not go to plan. Similarly, we are committed to full and open communication with patients and their families. It is internationally recognised that systems that support proactive reporting and investigation of clinical incidents are essential for learning to inform system improvements that reduce avoidable harm to patients.

In 2018-19 the WA Country Health Service utilised learnings from our clinical incident reporting and investigations to strengthen our services in the following areas:

  • The WA Country Health Service Patient Safety Matters newsletter publication continues to be a valuable avenue of de-identified feedback to our clinicians using themes identified through our clinical incident monitoring and reporting system to highlight opportunities for improvement, share lessons learnt and promote discussion across our many hospitals and health services. In 2018-2019 the publication included topics such as improving communication with community health services, preventing sepsis, minimising complications associated with central venous catheters and improving emergency equipment checking processes in remote area clinics.
  • Early recognition and management of cognitive impairment – dementia and delirium are two common conditions associated with cognitive impairment which affects communication, attention, memory, thinking and problem solving. Cognitive impairment can put patients at risk of harm such as experiencing falls, developing pressure injuries or malnutrition. During 2018-19 WA Country Health Service implemented a range of best practice resources to support clinicians to screen and assess patients who may be ‘at risk’ of cognitive impairment and put in place simple preventative measures to reduce the risk of cognitive impairment developing and manage cognitive impairment if it occurs.
  • An incident in a small WA Country Health Service Emergency Department involving a suicidal young person led to review of the supports available to general nursing staff needing to assess suicide risk. The existing tick box risk assessment form wasn’t contemporary. It focused on rating risk numerically, rather than on safety planning as a collaborative process carried out with, and not to, a person. Following consultation, and in line with state-wide policy, a new contemporary Suicide Risk Assessment and Safety Plan was developed, supported by a comprehensive learning package available to all staff through the Learning Management System. The focus is now on upskilling staff to work with a person in distress to help them stay safe, until they can be reviewed by a mental health clinician.

Notwithstanding the significant effort we invest in ensuring safe and high quality care for our patients, sometimes the health care does not go to plan. In these instances clinical incidents are reported and assigned a Severity Assessment Code (SAC) rating that guides the level of investigation that is to take place.

SAC 1 clinical incidents are the most serious category resulting in serious harm or death that is, or could be, specifically caused by health care rather than the patient’s underlying condition or illness. All SAC 1 clinical incidents are investigated in line with the WA Health Clinical Incident Management Policy. We have a well-developed approach to the review of these clinical incidents, and this includes oversight at the highest level by our Board Safety, Quality and Performance Committee.

During 2018-19, there were 116 incidents reported with a Severity Assessment Code rating of ‘1’ (SAC 1). These incidents represent a very small proportion of the 129,000 annual admissions, over 450,000 outpatient appointments and nearly 400,000 patients who presented to our emergency departments. Just under one quarter of the SAC 1 events resulted in no harm to the patient but were considered “near misses” that may have but did not cause harm, often through the timely intervention of our staff.

Of the 116 SAC 1 incidents, the patient outcome was noted as follows:

Patient outcomeNumber
Death 36
Serious harm 54

No harm (near miss that may have but
did not cause harm, either by chance
or through timely intervention)

26
Total 116

WA Country Health Service applies a low threshold for reporting clinical incidents. Consistent with this approach, there were also 21 incidents that were originally reported as SAC 1 and were declassified following investigation findings that the health care provided was determined not to have contributed to the poor patient outcome and only factors related to the patient’s clinical condition were identified.

Three SAC 1 clinical incident reported in 2018-19 met the criteria for reporting as a national sentinel event; one medication error and two suspected suicides of a patient in an acute psychiatric unit or acute psychiatric ward. National sentinel events are a discrete set of infrequently occuring SAC 1 events that are considered wholly preventable and caused serious harm or death to a patient.

In addition to our SAC review process, WA Country Health Service also participates in Health Roundtable, a national benchmarking organisation providing additional capability to report and analyse hospital mortality rates against comparable national peers.

"WA Country Health Service applies a low threshold for reporting clinical incidents."

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Our values in action

Call supports families and clinicians to respond early and save lives

Busselton resident Elizabeth Jenkins has become a vocal advocate for the Call and Respond Early ‘CARE Call’ process following an experience where her Mum became seriously unwell. Elizabeth says the call saved her Mum’s life.

WA Country Health Service has systems in place that ensures clinicians can quickly recognise and take appropriate steps to care for patients whose health deteriorates whilst they are in hospital. However, we also recognise that patients, their families or carers are often aware, before clinical staff, of subtle changes in their or their loved ones physical health, but may not feel comfortable, or know how to share their concerns with clinicians. The Call and Respond Early (CARE) Call is a process that our patients, their family or carers can initiate to raise their concerns with clinicians about the  health of themselves or a loved one in hospital or the care being provided. It ensures clinicians can quickly respond and take steps to care for patients whose health deteriorates whilst they are in hospital.

"I felt alarm bells ringing about Mum’s condition and despite the good care she was receiving, I felt further action was needed."
- Elizabeth Jenkins

Elizabeth said the situation arose when her Mum’s health deteriorated rapidly over a weekend. The family had taken their Mum to the Emergency Department in Busselton on a Saturday morning where she was diagnosed with an obstruction. She was transferred to Bunbury the following morning, but despite further testing and investigations, her Mum’s pain and overall condition continued to worsen.

Elizabeth’s CARE Call was prompted by a poster on the wall of the hospital room. The call led to a quick response from clinicians and expedited the process for her Mum to be sent to theatre where the cause of the 

sepsis was removed from her bowel. “That call got the right people in the room to assess her and hastened her listing for theatre,” said Elizabeth. “In distressing times like this, it’s difficult for family members and loved ones to know what they can do to assist.”
Elizabeth’s Mum recovered from surgery and is doing well despite some other health issues. Reflecting on the experience, Elizabeth said it was a lesson in trusting your instincts. “I am grateful to all the staff who cared for Mum, particularly the excellent work of the surgical team which resulted in a good outcome,” she said.

"I believe the CARE call, which essentially allows you to escalate your concerns, is an outstanding and invaluable service and in our case, it was a life saver."

View website - Read more about the CARE Call process, and find details for your local hospital

[Image (PDF only): Busselton resident Elanne Jenkins with puppy Rosie.]

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Falls and pressure injuries

Along with healthcare associated infections, falls and pressure injuries are common causes of harm in health care.

WA Country Health Service has processes that are consistent with the National Safety and Quality Health Service Standards to reduce the risk of patients and residents from falling or developing a pressure injury. Falls and pressure injury data is discussed routinely at quarterly regional Business Performance Meetings demonstrating recognition of the impact to a patient, their carer and community.

Falls

The WA Country Health Service Falls Management Committee plays a key role in promoting improvements in the prevention and management of falls across our sites. The committee enables the sharing of regional quality improvement activities, reflecting local responses to falls risk that vary between our regions based on population characteristics. In 2019 the committee commenced exploring technological solutions to detect and prevent falls in high risk patients.

Strategies in place to improve the prevention, early recognition and management of patients at risk of developing cognitive impairment will positively impact patients also at risk of falling whilst in hospital or residential aged care.

The WA Country Health Service inpatient rate of falls is below the Australian Council of Healthcare Services inpatient rate as outlined in Chart 1.

Pressure injuries

WA Country Health Service has in place a range of clinical policy resources for specific patient groups (e.g Adult inpatient, Residential Aged Care residents, Maternity and Paediatric patients) that guide:

  • Appropriate prevention and management of pressure injuries;
  • Informing and involving consumers in the collaborative development of pressure injury management plans (e.g. Department of Health Patient First resources); and
  • Documenting and reporting the occurrence of pressure injuries in the patients’ medical record and the WA Health Enterprise Clinical Incident Management system.

Pressure Injury data is discussed routinely at quarterly regional Business Performance Meetings.

The WA Country Health Service inpatient rate of pressure injuries is below the Australian Council of Healthcare Services inpatient rate as outlined in Chart 2.

[Chart 1 (PDF only): Rate of inpatient falls 2016-17 to 2018-19 (Note, approximate values only). ACHS inpatient falls rate per 1,000 bed days 2017: 3.25; WACHS average inpatient fall rate per 1,000 acute bed days Q1 16/17 - Q4 18/19: 1.75; Inpatient Falls rate per 1,000 bed days per quarter: 2016/17 Q1: 1.3; 2016/17 Q2: 1.7; 2016/17 Q3: 1.4; 2016/17 Q4: 1.5; 2017/18 Q1: 1.55; 2017/18 Q2: 1.3, 2017/18 Q3:2.1; 2017-18 Q4: 2.2; 2018-19 Q1: 2; 2018-19 Q2: 1.75; 2018-19 Q3: 1.85; 2018-19 Q4: 2.25]

[Chart 2 (PDF only): Rate of inpatients who develop one or more pressure injury 2016-17 to 2018-19 (Note, approximate values only). ACHS pressure injury rate per 1,000 bed days 2017: 0.72; WACHS average pressure injury rate per 1,000 acute bed days Q1 16/17 - Q4 18/19: 0.62; Pressure injury rate per 1,000 bed days: 2016/17 Q1: 0.53; 2016/17 Q2: 0.73; 2016/17 Q3: 0.57; 2016/17 Q4: 0.49; 2017/18 Q1: 0.58; 2017/18 Q2: 0.65, 2017/18 Q3: 0.64; 2017-18 Q4: 0.6; 2018-19 Q1: 0.55; 2018-19 Q2: 0.62; 2018-19 Q3: 0.72; 2018-19 Q4: 0.65]

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Preventing healthcare associated infections

Healthcare-associated infections are the most common complication affecting patients in hospitals. They cause patients pain and suffering, prolong hospital stays and can cause significant morbidity and mortality.

At least half of healthcare-associated infections are thought to be preventable with infection prevention and control practices and all healthcare facilities should aim to eliminate these infections.

Effective hand hygiene, through hand washing or applying alcohol-based hand rub, is the single most effective action to reduce healthcare-associated infections.

Over the last decade the National Hand Hygiene Initiative has been operating with the aim to improve hand hygiene compliance among health care workers and includes auditing of hand hygiene compliance nationally three times a year. In 2018/19 overall compliance with hand hygiene for WA Country Health Service has remained above the national hand hygiene benchmark of 80% set by the Australian Health Ministers’ Advisory Council.

Staphylococcus aureus is a type of bacteria, often found on the skin of healthy people that can cause an infection of the bloodstream after a patient receives medical care or treatment in hospital. Contracting a Staphylococcus aureus bloodstream infection while in hospital can be life threatening.

Figure 2: WACHS rate of hand hygiene compliance 2018/19

[Image (PDF only): 87.2%]

The WA Country Health Service contributes to the surveillance of Healthcare-associated Staphylococcus aureus bloodstream infections (HA-SABSI) through the Department of Health Healthcare Infection Surveillance Western Australia (HISWA) program.

Public reporting of performance on HA-SABSI rates for WA Country Health Service hospitals is available through the MyHospitals website.

HA-SABSI’s are measured as a rate of infection using the number of beds occupied by patients each day. The HISWA program has a HA-SABSI benchmark rate of less than or equal to 1.0 per 10,000 bed days of patient care for public hospitals.

Healthcare-associated Staphylococcus aureus bloodstream infection rates at WA Country Health Service hospitals had increased in the first half of 2018/19 to be above the HISWA target, however the HA-SABSI rate has decreased below the target rate in Q3 2018/19 (Q4 2018/19 data not available at time of report). In 2018-19 (Q1 -3) 75% of the reported HA-SABSI in WA Country Health Service hospitals were related to intravascular devices and 10% related to a surgical procedure.

The WA Country Health Service Infection Prevention and Control Committee is reviewing aseptic technique training resources and competency assessment processes for our clinicians. Clinical policies and resources relating to the care and management of peripheral intravascular devices have been updated to align with best practice.

"Effective hand hygiene, through hand washing or applying alcohol-based hand rub, is the single most effective action to reduce healthcare-associated infections."

View websitemyhospitals.gov.au

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Patient experience and satisfaction

The Patient Evaluation of Health Services survey is conducted annually to gauge patient satisfaction levels with WA Country Health Service hospitals. In 2018–19, the Department of Health surveyed 2,802 people who attended our hospitals asking them about their health care experiences during their stay in hospital.

Responses from these questions are used to calculate the:

  • Overall indicator of satisfaction – reflects how patients rate the experience of their hospital stay (i.e. getting into hospital; the time and attention spent on patient care; co-ordination and consistency of care; meeting personal as well as clinical needs; information and communication; involvement in decisions about care and treatment; and residential aspects), weighted by the relative importance patients place on these aspects.
  • Outcome score – reflects how patients rate the outcome of their hospital stay (i.e. the impact on physical health and wellbeing).

In this year’s annual report, admitted patients (children aged 0-15 years and adults aged 16-74 years) who were in hospital from 0-34 nights are presented for WA Country Health Service. The survey participation rate was 96 per cent, with 1,967 admitted adult patients and 835 admitted child* patients interviewed.

Chart 3 shows that for both admitted child and adult patients the patient rated Outcome of their visit as higher than their Overall Indicator of Satisfaction. This suggests that although patients were satisfied with their experience in WA Country Health Service hospitals, they were even more satisfied with the outcome of their hospital visit and the improvement in their condition. Additionally, both admitted child and adult patients Overall Indicator of Satisfaction and Outcome scores were higher for WA Country Health Service when compared with the State scores.

[Chart 3 (PDF only): Patient-rated overall satisfaction with health care compared to their satisfaction of the outcome, WACHS and State admitted child and adult patients, 2018–19]

Admitted Children
WACHS State
Overall indicator of satisfaction Outcome score Overall indicator of satisfaction Outcome score
80.8 91 80.5 89.9
Admitted Adults
WACHS State
Overall indicator of satisfaction Outcome score Overall indicator of satisfaction Outcome score
82.9 87.8 82.2 87.4

* Note: Interviews for children 0–15 years are completed by a parent or carer on behalf of the child.

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