Hospital acquired complications in South Australian major public hospitals

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, subdivided 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.