Adverse events in Australian hospitals
In the Quality in Australian Health Care Study, an adverse event was defined as:
'An unintended injury or complication which results in disability, death or
prolongation of hospital stay and is caused by health care management rather
than the patient's disease'.1
Modern health care is complex and risky and there is a known and significant incidence of
adverse events. According to the former Australian Council for Safety and Quality in Health
Care, the rate of adverse events in Australian hospitals is likely to be 10%, with the highest
incidence of harm occurring as a result of medication errors, infections, transfusion of blood and
blood products, patient falls and pressure ulcers.2
A proportion of patients die or suffer permanent serious injury as a result of adverse events in
Australian hospitals and health services. The Australian health care system is focusing,
increasingly, on detecting, investigating, managing and preventing reoccurrence of adverse
events.
Most commentators recognise that even the best health care professionals can (and do) make
mistakes:
"It is important to recognise that human error is inevitable for even the besttrained and best-qualified healthcare providers."3
The primary concern for most health care professionals when a patient is harmed is the
personal consequences for the patient and their carers. Dealing with serious adverse events
can be a very challenging issue for those who are committed to curing, not harming, patients.
Increasingly, the health care system is recognising that health care professionals require
significant personal and professional support at such times.
In recent years through initiatives such as Root Cause Analysis and Mortality and Morbidity
Committees, hospitals and health services have become more transparent in their management
of adverse events, allowing the circumstances of the event to be fully investigated and actions
to be taken to stop similar events reoccurring in the future. This approach recognises the
systems basis of clinical risk and is consistent with contemporary knowledge about the causes
and prevention of adverse events. It is important that health care professionals participate in
and cooperate with efforts to make our systems for the delivery of care safer.
1
Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med
J Aust 1995; 163: 458-471
2
Australian Council for Safety and Quality in Health Care. Adverse events rates fact sheet.
Accessed on 9 September 2007 at http://www.safetyandquality.org/internet/safety/
publishing.nsf/Content/6A2AB719D72945A4CA2571C5001E5610/$File/advrsefact.pdf
3
Wilson RM, Harrison B, Gibberd RW, Hamilton JD. An analysis of the causes of adverse events
from the Quality in Australian Health Care Study. Med J Aust 1999; 170: 411-415
4
Medico-legal claims in Australian hospitals
If a mistake occurs that results in significant harm or ongoing disability, a claim of negligence
may be made (see the discussion on the law of negligence commencing on page 8 of this
manual). It follows that all health care professionals, including those who are highly motivated
and competent, may at some stage in their career face an allegation that they have been
negligent.
The risk of a successful claim of negligence is not limited to high complexity care - errors
leading to successful claims of negligence have been reported frequently in low complexity
settings. For example, failing to properly supervise a patient who is assessed to be at risk of
falling may have serious permanent consequences for the patient giving rise to a successful
claim in negligence.
Nevertheless, the likelihood that an individual patient will claim damages as a consequence of
an adverse health care event remains low in Australia.
Public sector medico-legal claims during 2004/05 across Australia showed the following
patterns:4
x the three most frequently recorded clinical service contexts associated with medical
indemnity claims were obstetrics (1,141 claims; 18% of all claims), accident and
emergency (940 claims; 15%) and general surgery (721; 11%);
x obstetrics only (715 claims), emergency medicine (610 claims) and general surgery
(489 claims) were the most commonly recorded specialties of clinicians involved in
incidents that gave rise to claims. Nurses were the primary clinicians involved in 361
claims;
x data on primary incident/allegation type show that medical or surgical procedures
(2,163 claims; 34% of all claims) were most commonly recorded in medical indemnity
claims, followed by diagnosis (1,324; 21%) and treatment (947; 15%); and
x the majority of claims arose from events that occurred in major cities (4,407 claims;
68%); 1,930 claims (30%) arose from incidents that occurred in regional areas, and
91 claims (1.4%) arose from incidents that occurred in remote areas. This pattern
most probably reflects the concentration of medical services in Australia in
metropolitan areas.
Although traditionally the majority of claims of negligence have been directed against medical
practitioners and/or hospitals, nurses are exposed to medico-legal risk. Nurses played the most
prominent role in the events that gave rise to 361 of a total of 6,453 reported medico-legal
incidents in Australian public hospitals in 2004-05 - approximately 6% of total incidents.5
They
are, however, rarely named as defendants in litigation. It is usually a nurse's employer hospital
or health service which is named as the defendant in an action in negligence.
4
AIHW (Australian Institute of Health and Welfare) 2006. Medical indemnity national data
collection, public sector 2004–05. AIHW cat. no. HSE 42. Canberra: AIHW.
5
Incidents giving rise to actual or potential medico-legal claims.
