23

Agency performance

24

A snap shot of health care provided by SMHS

Close to 237,900 patients attended more than

outpatient appointments.

Our emergency departments

treated more than

patients.

More than of our emergency presentations

were children (0–15 years).

Our hospitals delivered

inpatient care more than

times.

Approximately 49% of inpatient care is provided to patients aged 60 years or older.

More than babies were delivered during

the year in our hospitals, with 17 babies being born

in one 24-hour period at Fiona Stanley Hospital.

25

Our transplant teams

changed the lives

of patients

by performing:

11 heart transplants

14 lung transplants

48 kidney transplants

83 bone marrow transplants

02 heart and lung transplants.

More than 5,000 patients received in

excess of occasions of

service in their home or in a community setting after discharge from our hospitals.

Surgical teams performed more than

elective and

1,500 emergency surgeries.

Hospital-based mental health teams

provided care to more

than

consumers.

Our mental health

community-based

teams assisted more than

consumers by delivering close to

170,000 occasions

of service in homes or a community setting.

Our intensive care teams treated more than

patients.

Rural and remote patients received care via

telehealth or telephone on more than

occasions; saving the need

to travel to Perth for treatment.

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Financial targets

The total cost of SMHS providing health

services in 2016–17 was $1.81 billion.

Results for 2016–17 against agreed

financial targets (based on Budget

statements) are presented in Table 1.

Full details of the SMHS’s financial

performance during 2016–17 are

provided in the financial statements

(page 51).

Table 1: Actual results versus budget targets for SMHS

2016–17 Estimates

$’000

2016–17 Actual $’000

Variation $ +/–

Total cost of service 1,637,130 1,811,283 174,153

Net cost of service 963,170 1,003,815 40,645

Total equity 2,480,591 2,384,484 -96,107

Net increase/decrease in cash held

(514) 19,352 19,866

Approved salary expense level 857,133 935,597 78,464

Agreed borrowing limit 222,178 231,072 8,894

Note:

� The target column represents the approved 2016/17 Financial Management Act s40 estimates

2016–17 Agreed limit

$’000

2016–17 Target/Actual

$’000

Variation $ +/–

Working cash limit (at budget) 40,283 40,283 N/A

Working cash limit (at actuals) 40,130 40,310 180

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Summary of key performance indicators A summary of SMHS key performance indicators and variations from the 2015–16 targets are given in Table 2. This is to be read in conjunction with detailed information on each key performance indicator found in the Disclosure and Compliance section (page 45) of this report.

Key performance indicators assist SMHS to assess and monitor the extent to which Government outcomes are being achieved:

� Effectiveness indicators provide information that aid with assessment of the extent to which outcomes have been achieved through the resourcing and delivery of services to the community.

� Efficiency indicators monitor the relationship between service delivery and the resources used to produce the service.

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Table 2: Actual results versus KPI targets

Key performance indicator2016–17

Target2016–17

ActualVariation

Outcome 1: Restoration of patients’ health, provision of maternity care to women and newborns, and support for patients and families during terminal illness

Key effectiveness indicators

Percentage of patients discharged to home after admitted hospital treatment ≥ 98.4% 98.3% -0.1%

Survival rates for sentinel conditions Survival rate for stroke, by age group 0–4950–5960–6970–7980+

≥95.3%≥92.8%≥93.3%≥90.8%≥83.3%

96.5%98.8%91.2%93.4%86.7%

1.2%6.0%

-2.1%2.6%3.4%

Survival rate for acute myocardial infarction, by age group

0–4950–5960–6970–7980+

≥99.5%≥99.2%≥98.4%≥96.7%≥92.7%

98.7%100.0%100.0%

97.2%94.3%

-0.8%0.8%1.6%0.5%1.6%

Survival rate for fractured neck of femur, by age group 70–7980+

≥99.0≥96.4

100.097.1

1.0%0.7%

Proportion of elective wait list patients waiting over boundary for reportable procedures Urgency Category 1 Urgency Category 2Urgency Category 3

=0=0=0

22.6%30.9%

4.8%

-22.6%-30.9%

-4.8%

Unplanned hospital readmissions within 28 days for selected surgical procedures (per 1000 separations)

Knee replacementHip replacementTonsillectomy and adenoidectomyHysterectomyProstatectomyCataract surgeryAppendicectomy

≤22≤21≤71≤47≤34

≤1≤39

2110974930

132

111

-26-2407

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Key performance indicator2016–17

Target2016–17

ActualVariation

Rate of unplanned readmissions within 28 days to the same hospital for a mental health condition (per 1000 admissions) ≤66 64 2

Percentage of liveborn term infants with an Apgar score of less than seven at five minutes post delivery ≤1.8% 1.1% 0.7%

Key efficiency indicators

Average cost per casemix adjusted separation for tertiary hospitals $9,267 $8,378 -$889

Average cost per casemix adjusted separation for non-tertiary hospitals $7,708 $6,961 -$747

Average cost per bed-day for admitted patients (small hospitals) $990 $1,088 $98

Average cost per emergency department attendance $721 $808 $87

Average cost per public patient non-admitted activity $338 $383 $45

Average cost per trip of Patient Assisted Travel Scheme $39 $23 -$16

Outcome 2: Enhanced health and wellbeing of Western Australians through health promotion, illness and injury prevention and appropriate continuing care

Key effectiveness indicators

Percentage of contacts with community-based public mental health non-admitted services within seven days prior to admission to a public mental health inpatient unit

≥70% 63% -7%

Percentage of contacts with community-based public mental health non-admitted services within seven days post discharge from public mental health inpatient units.

≥75% 79% 4%

Key efficiency indicators

Average cost per capita of Population Health Units $29 $25 -$4

Average cost per bed-day in specialised mental health inpatient units $2,299 $2,098 -$201

Average cost per three month period of care for community mental health $977 $1,648 $671

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Access performancePercentage of emergency department patients seen within recommended timesWhen patients first enter an emergency department (ED) they are assessed on how urgently treatment should be provided. A patient is allocated a triage category between 1 (immediate) and 5 (least urgent) that indicates their treatment acuity. Treatment should commence within the recommended time of the triage category allocated (see Table 3). The aim of this process is to ensure treatment is given in the appropriate time and should prevent adverse conditions arising from deterioration in the patient’s condition.

Table 3: Triage category, treatment acuity and WA performance targets

Triage category Description Treatment acuity Target

1 Immediate life-threatening Immediate (≤2 minutes) 100%

2 Imminently life-threatening ≤10 minutes ≥80%

3 Potentially life-threatening or important time-critical treatment or severe pain

≤30 minutes ≥75%

4 Potentially life-serious or situational urgency or significant complexity ≤60 minutes ≥70%

5 Less urgent ≤120 minutes ≥70%

Note:

� The triage process and scores are recognised by the Australasian College for Emergency Medicine.

With the increasing demand on emergency departments and health services, it is important to continually monitor performance to assist in developing strategies to manage the demand on emergency department services and the effectiveness of service provision.

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In 2016–17, 88 per cent of all triage 5 patients were seen within the clinically recommended time, above the target of 70 per cent. (see Table 4). The Australasian College for Emergency Medicine targets for patients categorised as triage 1, 2, 3 and 4 were not met (see Table 4).

Table 4: Percentage of SMHS emergency department patients seen within recommended times, by triage category, 2016–17

Total ED attendances

Percentage seen on time

Triage 1 Triage 2 Triage 3 Triage 4 Triage 5 Total

Fiona Stanley Hospital 102,472 99.8% 70% 30.2% 53.4% 86.1% 50%

Rockingham General Hospital 54,027 100% 84% 53.8% 68.8% 89.8% 66%

Peel Health Campus 43,753 55.6% 60.8% 39.5% 55.8% 91.7% 53.8%

Health Service Total 200,252 95.3% 72% 38.6% 58.3% 88% 55.2%

Data sources: Emergency Department Data Collection.

SMHS recognises this is a critical performance indicator in the delivery of safe and quality clinical care and has developed a methodical approach within each hospital to help achieve sustained results. PHC has implemented a reporting improvement plan, which has led to a marked improvement since January 2017. This plan includes auditing reported breaches in the Emergency Department Patient Management System (PMS) against the medical record and correcting the PMS where documentation supports an amendment.

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Towards Zero Harm – investigating clinical incidentsSMHS supports a culture of zero harm where we strive towards causing no harm to our patients. SMHS encourages openness, transparency and continual improvement of the safety, quality and effectiveness of care provided to our patients. As part of the zero harm approach SMHS takes all clinical incidents seriously and to prevent recurrence, ensure there is systematic and in-depth identification, investigation and implementation of learnings.

The clinical incident management process is undertaken in accordance with the WA Clinical Incident Management Policy and the WA Open Disclosure Policy Statement. The principles of open disclosure ensure SMHS communicates with and support patients, and their family and carers, who have experienced harm during healthcare in an open and timely manner.

There were 165 severity assessment code (SAC) 1 clinical incidents notified for 2016–17. At the time of reporting (13 September 2017) the investigation of 158 incidents were completed and seven (7) are ongoing. Of the 143 clinical incidents investigated:

� 118 cases were confirmed as SAC1 clinical incidents

� 40 were declassified following investigation as the healthcare provided was determined not to have contributed to the poor patient outcome.

For the confirmed 118 SAC1 clinical incidents where health care was found to be a contributing factor:

� 19 were associated with a patient’s death

� 37 with serious harm

� 44 with minor to moderate harm.

In addition, there were 18 SAC1 clinical incidents where no harm occurred, but were considered to have had the potential for harm. These were investigated as clinical incidents so recurrence could be prevented.

SMHS acknowledges serious clinical incidents results in difficult times for patients, their families and our staff. SMHS recognises the importance of learning from these incidents, and supporting families, carers and staff through the investigation and open disclosure processes.

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Table 5: SMHS SAC1 clinical incidents 2016–17

SAC1 clinical incidents Number

Notified 165

Investigated 158

Ongoing investigation 7

Declassified* 40

Total confirmed 118

Confirmed with patient outcome of death#

19 (16%)

Confirmed with patient outcome of serious harm

37 (31%)

Confirmed with patient outcome of minor to moderate harm

44 (37%)

Confirmed with patient outcome of no harm

18 (15%)

Note:

* Declassification of a reported SAC1 clinical incident may occur following thorough investigation if it is identified that no healthcare causative factors contributed to the incident. Declassification requests are reviewed by two Department of Health senior clinicians who have extensive experience in safety and quality in healthcare. Declassification means that the event is no longer considered to be a clinical incident.

# For some of these incidents, other factors may be involved, and therefore healthcare was not the only contributing factor or direct cause of the patient’s death.

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Learnings from a serious clinical incident A paediatric patient with insulin-dependent diabetes presented to an Emergency Department (ED) after three days of nausea and vomiting. He was diagnosed with diabetic ketoacidosis and due to his extremely high blood sugar level was treated with intravenous fluids and insulin injections.

The patient was admitted and during subsequent treatment was accidentally administered 55mmol/L instead of 5.5mmol/L of insulin. This medication error was realised immediately and the patient’s mother and paediatrician were informed.

The patient was reviewed by the paediatrician, commenced on a dextrose infusion and advice sought from an endocrinologist at Princess Margaret Hospital (PMH). The patient remained alert during this time and was transferred, via ambulance with a nurse escort and his mother, to PMH where the patient was admitted and treatment continued. The patient was discharged home two days later.

The investigation panel determined:

� Usual practice is to refer children with diabetic ketoacidosis to a tertiary paediatric service for ongoing management; however, the patient’s mother’s preference was for the patient to be admitted to this hospital and, given the patient’s stabilisation in ED, the patient was admitted.

� Availability of 100 unit syringes in the clinical area increased the risk of the incorrect dose.

� Paediatric staff were unfamiliar with administering insulin from a syringe as diabetic patients under 16-years of age are usually transferred to a tertiary paediatric centre.

� Medical staff were familiar with prescribing a particular rapid-acting insulin, which only comes in vials, compared to another rapid-acting insulin which is available in a safer pen device.

RecommendationsAs a matter of urgency the following actions were implemented:

� Immediate replacement of 100 unit syringes with 50 unit syringes in the clinical area.

� Implementation of staff education and training regarding the use of 50 unit syringes.

� Review of the site Clinical Practice Standards (CPS) Policy to ensure the CPS for adult inpatient diabetes management has links to the PMH diabetes management guidelines for children.