Australia: Public hospital management and staff pass the buck

A FOUR-YEAR study of NSW hospitals has revealed staff and senior health bureaucrats blame each other for shocking errors, including deaths of patients. The statewide "safety check" found patients were at significant risk of death or injury from falls, medication errors, staffing levels, lax infection control and mistakes in diagnosis and treatment.

Doctors and nurses overwhelmingly agreed that chronic understaffing and heavy reliance on inexperienced junior staff was a major risk - especially after-hours and in complex areas such as emergency and intensive care. But the area health service managers blamed adverse incidents on mistakes made by medical and nursing staff rather than problems with skill mix.

Opposition Health spokeswoman Jillian Skinner said it was "scandalous" that it has been five years since the Walker inquiry into 21 deaths at Campbelltown and Camden hospitals recommended an urgent audit of risks in the health system. Since then internal reports into 85 deaths over two years at western Sydney hospitals revealed that at least 49 of the patients did not receive adequate care.

Most of the avoidable deaths were due to a delay in responding to a rapidly deteriorating patient, the Annual Review of Root Cause Analysis 2006 and 2007 found. But the chief executive of the $55 million Clinical Excellence Commission, Professor Clifford Hughes, defended the Quality Systems Assessment report released today, saying a great deal of developmental work had been done to get an accurate picture of the state's complex health system. Professor Hughes said allowing everyone from the ward staff to hospital managers to top-level administrators to nominate their three highest risks to patient safety showed there was a significant disparity between the issues front-line staff saw as important, and the priorities of management.

The report found dozens of patient safety programs had been implemented since 2004 but very few had been reviewed to assess if they actually worked. Four of the eight area health services, and the Children's Hospital at Westmead, did not have any systems or processes for reviewing deaths. It also found confusion and lack of clear policy in many areas.

The director of the Institute of Health Innovation at the University of NSW, Jeffrey Braithwaite, commended the report but said collecting information was just the first step. "On too many initiatives in NSW we've seen things chopping and changing."

Health Minister John Della Bosca said 89 per cent of respondents felt there had been an improvement in patient safety and quality culture in the past two years. "This rigorous program is a world first for the assessment of quality and safety processes in a health system that will help us achieve ongoing improvements."

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