Quarterly DHB Hospital Benchmark Info Released
30 November 2005
The latest quarterly DHB Hospital Benchmark Information report is released
The District Health Board Hospital Benchmark Information report released today shows that emergency department staff are maintaining performance despite facing an increased number of serious cases.
The DHB Hospital Benchmark Information Reportcovers from April 2005 to June 2005. The reports are published quarterly to report on data supplied by the hospital services in District Health Boards (DHBs). The information is divided into quadrants (organisational health, quality and patient satisfaction, process and efficiency and financial) that give different perspectives of the running of DHBs.
One area of particular focus in the report has been the waiting times in emergency departments (emergency triage times). The Ministry reviews data for codes 1-3, the most serious of the 5 codes. Over the last two years, the numbers of triage code 1, 2 and 3 patients has shown an overall increase, but emergency department staff have managed to maintain the same level of performance, even with this increase in numbers of patients. In the June 2005 quarter, four DHBs met the benchmarks for all three emergency triage times. Three other DHBs met the benchmarks for triage codes 1 and 2 (the more serious need for treatment). For the June 2005 quarter across all DHBs, two code 1 patients were recorded as not having treatment commenced by a doctor on arrival.
Deputy Director-General DHB Funding and Performance, Anthony Hill says, "Throughout 2004/05, the Ministry of Health communicated with DHBs and relevant clinical groups to work towards improving the results for the emergency triage times. Although nearly all triage code 1 patients were recorded as seen immediately during 2004/05 it is hoped that the results for codes 2 and 3 will improve in 2005/06. Some of the required improvements are not related to clinical practice, but rather to recording mechanisms, including computer systems".
The total number of hospital acquired bloodstream infections reported in the June 2005 quarter was 394 for all DHBs combined. The number was fairly stable for the whole of 2004/05.
In the last three years, the combined (inpatients and outpatients) patient satisfaction rate for all DHBs has varied very little, fluctuating between 87.56% and 88.05%. The rate for all DHBs combined was 87.88% for the June 2005 quarter.
The overall average length of stay continued to trend down and was lower in 2004/05 than 2003/04. The overall rate for the June 2005 quarter was 3.21 days.
Mr Hill says, "Data for the report is collected using specific criteria. In parts of the report, targets are set and some of the targets are high and difficult to achieve, but worthwhile because they impact on patient care.
"Comparisons using the hospital benchmark information data must always be undertaken with caution. There are differences among the 21 DHBs as they are not all the same size, cover different population needs and provide different services. Their populations, ages, ethnicities, and health status are all unique.
"The DHBs are also structurally different with the smallest DHB only having one hospital and one emergency department, whereas other DHBs have several hospitals and several emergency departments. Therefore the results must be taken in context and not as absolute."
The DHB Hospital Benchmark Information Report: April - June 2005is available at www.moh.govt.nz
What is the DHB Hospital Benchmark Information report?
The report is compiled by the Ministry of Health from data supplied by the hospital services in District Health Boards. The first Hospital Benchmark Information report was published at the end of the March 2004 quarter. It evolved from the Balanced Scorecard report that was originally developed by the Crown Company Monitoring and Advisory Unit (CCMAU) to monitor the hospitals of the then Hospital and Health Services.
What does the report contain?
The information is divided into quadrants (organisational health, quality and patient satisfaction, process and efficiency and financial) that give different perspectives of the running of hospital services in DHBs.
Results can be reviewed over time and an individual DHB's results can be compared with the average of all DHBs. It is important that readers of the report differentiate between 'raw' data such as the number of individual incidents (eg staff work-related injuries or illnesses), and the 'staff work-related injuries or illnesses rate', which is calculated dividing the number of individual incidents by the total number of hours worked by all employees.
What is the Emergency Department Triage rate ?
The Emergency Department Triage time is the "time elapsed between presentation at an emergency department (time recorded) and time of commencement of treatment by a doctor".
Doctors cannot always see and treat patients within the timeframes because of the fluctuations in the number of patients, the seriousness of their conditions and other pressures on resources. In acknowledgement of these fluctuations, benchmarks are set that indicate the acceptable percentage of patients who will be seen within the timeframes.
The Hospital Benchmark Information report uses the Australasian College for Emergency Medicine (ACEM) benchmarks. These benchmarks are recognised by emergency department clinicians as being quite high. If emergency departments are not meeting the benchmarks, this may mean that there are more patients waiting for longer than the ideal time to see a doctor and start treatment. However, investigation by the Ministry has shown that a result indicating failure to meet the benchmarks is sometimes a recording error (eg, wrong triage code, staff using watches/clocks with different times on them, staff concentrating on treatment and recording times afterwards) or a problem with a computer system. DHBs are working to correct these problems to ensure more accurate reporting.
It should be emphasised that the waiting items for this indicator reflect the time to get treatment by a doctor and, in many cases, good clinical care is in place prior to a doctor beginning treatment. In some instances, treatment is not started by a doctor within the triage time, but may begin a few seconds after. The results for this indicator do not indicate whether patients waited a long time or a short time after the triage time had expired.
What is the Hospital Acquired Bloodstream Infection rate?
In New Zealand and other developed countries, approximately 10% of hospital patients acquire an infection that was neither present, nor incubating when they were admitted to hospital. Of all hospital-acquired infections, bloodstream infections are associated with the greatest rates of illness and death.
There are several factors that increase the risk of patients acquiring a bloodstream infection. These factors include the number of intravenous or intra-arterial lines (drips/intravenous catheters) patients have (the greater the number of lines, the higher the risk). Another factor is the status of a patient's immune system (ie, the body's defence systems against infection) which can be weakened either by illnesses like leukaemia, or treatments such as chemotherapy.
Comparisons must be made with caution, as higher than average reported infection rate may indicate an efficient surveillance system rather than poor practice.
Can you use the data to compare DHBs?
Comparisons using the hospital benchmark information data must always be undertaken with caution. There are differences among the 21 DHBs as they are not all the same size, cover different population needs and provide different services. Their populations, ages, ethnicities, and health status will all be unique.
The DHBs are also structurally different, with the smallest DHB only having one hospital and one emergency department, whereas other DHBs have several hospitals and several emergency departments. For the Hospital Benchmark Information Report, the data from all hospitals and emergency departments in a DHB is combined to give one result for each DHB.
Readers of the report are advised to contact the DHB or DHBs concerned, before drawing conclusions from the information.
What is the purpose of the report?
The report is a tool for DHBs to improve performance (where required) in their hospital services. The intention is that DHBs that have similarities work with each other to understand why their results are different and take action when their results and subsequent investigations show their results are significant outliers from the norm and/or sector standards.