ORCID Profile
0000-0003-4790-6750
Current Organisations
Eastern Health
,
Monash University Eastern Health Clinical School
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 21-06-2022
DOI: 10.1111/IMJ.15468
Abstract: The national hospital-acquired complication programme captures complications arising from patient-related and hospital-related factors, but the proportion of the two is unclear. Health services are encouraged to evaluate data from the national hospital-acquired complications (HAC) programme and identify strategies to mitigate them. A retrospective chart review compared HAC extracted from administrative data. The setting was a 430-bed university-affiliated metropolitan hospital. Records from 260 participants with, and 462 without, reported HAC from 2619 multi-day stay adults were reviewed. The main outcome measures were prevalence and positive predictive value (PPV) of HAC methodology. No errors of HAC coding or classification were identified. Four hundred and twenty-three HAC events were reported in 260 records most commonly delirium (n = 57 13.4%), pneumonia (n = 46 10.9%), blood stream infection (n = 39 9.2%), hypoglycaemia (n = 33 7.8%) and cardiac arrhythmias (n = 33 7.8%). One hundred and eight (25.5%) 'HAC' events in 69 separations (95% confidence interval (CI) = 2.05-3.33 per 100 separations) were false positive, and 43 of 462 (95% CI = 6.72-12.22 per 100 separations) were false negative. Prevalence of total (reported plus missing) HAC was 16.06 (95% CI = 14.02-19.52), reported HAC was 9.93 (95% CI = 8.76-11.21), potentially preventable HAC was 1.68 (95% CI = 1.22-2.26) and healthcare errors was 0.31 (95% CI = 0.13-1.30) per 100 separations. PPV of HAC for true clinical events was 0.74 (0.68-0.79), preventable events 0.18 (0.13-0.23) and healthcare error 0.03 (0.01-0.06). Prevalence of HAC events was higher than expected, but PPV for healthcare errors was low, suggesting provision of care is a less common cause of HAC events than patient factors. HAC may be an indicator of hospital admission complexity rather than HAC.
Publisher: SAGE Publications
Date: 27-06-2022
DOI: 10.1177/18333583221107713
Abstract: Sepsis is the world’s leading cause of death and its detection from a range of data and coding sources, consistent with consensus clinical definition, is desirable. To evaluate the performance of three coding definitions (explicit, implicit, and newly proposed synchronous method) for sepsis derived from administrative data compared to a clinical reference standard. Extraction of administrative coded data from Australian metropolitan teaching hospital with 25,000 annual overnight admissions compared to clinical review of medical records 313 (27.9%) randomly selected adult multi-day stay hospital separations from 1,123 separations with acute infection during July 2019. Estimated prevalence and performance metrics, including positive (PPV) and negative predictive values (NPV), and area under the receiver operator characteristic curve (ROC). Clinical prevalence of sepsis was estimated at 10.7 (95% CI = 10.3–11.3) per 100 separations, and mortality rate of 11.6 (95% CI = 10.3–13.0) per 100 sepsis separations. Explicit method for case detection had high PPV (93.2%) but low NPV (55.8%) compared to the standard implicit method (74.1 and 66.3%, respectively) and proposed synchronous method (80.4% and 80.0%) compared to a standard clinical case definition. ROC for each method: 0.618 (95% CI = 0.538–0.654), 0.698 (95% CI = 0.648–0.748), and 0.802 (95% CI = 0.757–0.846), respectively. In hospitalised Australian patients with community-onset sepsis, the explicit method for sepsis case detection underestimated prevalence. Implicit methods were consistent with consensus definition for sepsis, and proposed synchronous method had better performance.
Publisher: Wiley
Date: 31-05-2020
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.51893/2021.3.OA5
Abstract: BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019) administrative dataset abstracted from medical records. SETTING: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. PARTICIPANTS: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). MAIN OUTCOME MEASURES: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] 0.3). RESULTS: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2–7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P 0.001), but was weakly associated with hospital site (ICC, 0.08 95% CI, 0.05–0.11). CONCLUSIONS: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.
Publisher: Wiley
Date: 25-08-2022
DOI: 10.1111/IMJ.15637
Abstract: Inhospital cardiac arrest (IHCA) is an uncommon but challenging problem. To investigate the management and outcomes of IHCA, and to investigate the effect of introducing a medical emergency team (MET) on IHCA prevalence. Retrospective medical record review of 176 adult IHCA episodes at Box Hill Hospital, a university‐affiliated public hospital in metropolitan Melbourne, from July 2012 to June 2017. Inpatients receiving cardiopulmonary resuscitation for IHCA, in inpatient wards, intensive care unit, cardiac catheterisation laboratory and operating theatres were included. Data collected included demographics, resuscitation management and outcomes. Average treatment effect (ATE) was derived from margins estimates and linear regression fitted to hospital outcome, adjusted for IHCA factors. An exponentially weighed moving average control chart was used to explore IHCA prevalence over time. There were 65.3% of IHCA patients who died in hospital. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with higher likelihood of survival to discharge were initial cardiac of rhythm ventricular tachycardia (VT) (ATE 0.10 (95% CI = −0.03 to 0.25)) or ventricular fibrillation (VF) (ATE 0.28 (95% CI = 0.11–0.46)), cardiac monitoring at the time of arrest (ATE 0.06 (95%CI = −0.04 to 0.16)) and time to return of spontaneous circulation (ATE 0.023 (95% CI = 0.015–0.031)). IHCA is uncommon and is associated with high mortality. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with improved survival to hospital discharge were initial rhythm VT or VF, cardiac monitoring and shorter resuscitation times.
Publisher: Wiley
Date: 12-2020
DOI: 10.1111/AJO.13103
Abstract: The incidence of severe acute maternal morbidity (SAMM) is one method of measuring the complexity of maternal health and monitoring maternal outcomes. Monitoring trends may provide a quantitative method for assessing health care at local, regional, or jurisdictional levels and identify issues for further investigation. Identify temporal trends for SAMM event rates and maternal outcomes over 17 years in the state of Victoria, Australia. All maternal public health service admissions were extracted from an administrative dataset from July 2000 to June 2017. SAMM-related diagnoses were defined by matching as closely as possible with published definitions. Outcomes included annual SAMM event rates, hospital survival, and hospital length of stay (LOS). Temporal trends were analysed using mixed-effects generalised linear models. There were 854 777 live births and 1.21 million pregnancy-related hospital admissions which included 34 008 SAMM events in 29 273 records and in 3.42% (95%CI = 3.39-3.46) of births. Most common were severe pre-ecl sia (0.87% of births), severe postpartum haemorrhage (0.59%), and sepsis (0.62%). SAMM-related admissions were associated with longer LOS and higher mortality risk (P < 0.001). Maternal mortality ratio remained unchanged at 8.6 fatalities per 100 000 births (P = 0.65). Over 17 years, there was a significant increase in birth rate and SAMM-related events in Victoria. Administrative data may provide a pragmatic approach for monitoring SAMM-related events in maternal health services.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.51893/2021.3.OA7
Abstract: OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic in Victoria, Australia. DESIGN: Retrospective observational cohort study. SETTING: All 45 hospitals with an ICU in Victoria, Australia. PARTICIPANTS: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. MAIN OUTCOME MEASURE: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. RESULTS: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4–1.7] v 0.6 [IQR, 0.3–1.2] P 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10 95% CI, 2.34–7.18 P 0.001). CONCLUSIONS: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
Publisher: Wiley
Date: 30-12-2022
DOI: 10.5694/MJA2.51375
Abstract: To quantify the prevalence of hospital-acquired complications to determine the relative influence of patient- and hospital-related factors on complication rates. Retrospective analysis of administrative data (Integrated South Australian Activity Collection Victorian Admitted Episodes Dataset) for multiple-day acute care episodes for adults in public hospitals. Thirty-eight major public hospitals in South Australia and Victoria, 2015-2018. Hospital-acquired complication rates, overall and by complication class, by hospital and hospital type (tertiary referral, major metropolitan service, major regional service) variance in rates (intra-class correlation coefficient, ICC) at the patient, hospital, and hospital type levels as surrogate measures of their influence on rates. Of 1 558 978 public hospital episodes (10 029 918 bed-days), 151 486 included a total of 214 286 hospital-acquired complications (9.72 [95% CI, 9.67-9.77] events per 100 episodes 2.14 [95% CI, 2.13-2.15] events per 100 bed-days). Complication rates were highest in tertiary referral hospitals (12.7 [95% CI, 12.6-12.8] events per 100 episodes) and for episodes including intensive care components (37.1 [95% CI, 36.7-37.4] events per 100 episodes). For all complication classes, inter-hospital variation was determined more by patient factors (overall ICC, 0.55 95% CI, 0.53-0.57) than by hospital factors (ICC, 0.04 95% CI, 0.02-0.07) or hospital type (ICC, 0.01 95% CI, 0.001-0.03). Hospital-acquired complications were recorded for 9.7% of hospital episodes, but patient-related factors played a greater role in determining their prevalence than the treating hospital.
Publisher: SAGE Publications
Date: 05-09-2022
DOI: 10.1177/0310057X221092460
Abstract: The prevalence of Hospital Acquired Complications (HACs) within major hospitals and intensive care units (ICUs) is often used as an indication of care quality. We performed a retrospective cohort study of acute care separations from four adult public hospitals in the state of South Australia, Australia. Data were derived from the Integrated South Australian Activity Collection (ISAAC) database, sub ided into those admitted to ICU or non-ICU (Ward) in tertiary referral or (other major) metropolitan hospitals. During the five-year study period (1 July 2013 to 30 June 2018), there were 471,934 adult separations with 65,133 HAC events reported in 43,987 (9.32%) at a mean rate of 13.8 (95% confidence interval (CI) 13.7 to 13.9) HAC events per 100 separations and 18.5 (95% CI 18.4 to 18.7) per 1000 bed days. The Ward cohort accounted for the majority (430,583 (91.2%)) of separations, in-hospital deaths (6928 (66.4%)) and HAC events (29,826 (67.8%)). The smaller ICU cohort (41,351 (8.76%)) had a higher mortality rate (8.46% versus 1.61% P 0.001), longer length of stay (median 10.0 (interquartile range (IQR) 6.0–18.0) days versus 4.0 (IQR 3.0–8.0) days P 0.001), and higher HAC prevalence (62.1 (95% CI 61.3 to 62.9) versus 9.16 (95% CI 9.07 to 9.25) per 100 separations P 0.001). Both ICU and Ward HAC prevalence rates were higher in tertiary referral than major metropolitan hospitals ( P 0.001). In conclusion, higher HAC prevalence rates in the ICU and tertiary referral cohorts may be due to high-risk patient cohorts, variable provision of care, or both, and warrants urgent clinical investigation and further research.
No related grants have been discovered for Graeme Duke.