UTI HAC – untangling TLAs (and $) and trying to keep it real

Helen Van Gessel1

1Western Australian Country Health Service

Background and Aim

The Hospital Acquired Complications (HACs) program of the Australian Commission on Safety and Quality in Health Care is based on two main premises

  • That provision of relevant and timely clinical information to clinicians and managers is an effective driver of safety and quality improvement
  • That application of financial penalties for HACs so identified will improve patient safety

The evidence behind these assumptions is being increasingly questioned.

For the WA Country Health Service, 28% of all 2016/17 HACs identified were urinary tract infections (UTIs).  Clinicians raised concerns regarding the validity of these findings, urging caution before action. We undertook to examine this further, and evaluated whether events detected as HAC UTIs fulfilled validated surveillance criteria.

Results and Conclusions

Of 62 HAC UTIs, only 7 (18%, 95% CI 10-29%) fulfilled CDC surveillance criteria.Furthermore, only 1 of 4 UTIs identified in a prospective CAUTI surveillance program using NHSN methodology was coded as a HAC UTI. Our data adds to others in challenging the premises on which the HACs program is based. For the last 20 years, we’ve been busy persuading clinicians and managers that many HAIs were preventable, and that counting them would be helpful to guide prevention strategies. Now, it seems we need to persuade non-clinicians that what they are counting are not infections OR healthcare associated and that counting these is not helpful and negatively impacts on patients and staff.

The presenter proposes this as an example of Dr Don Berwick’s observation of a major problem with modern healthcare – that we have “glutted” ourselves with metrics, and need a data diet.

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