Volume 200 - Issue 5
How should we interpret hospital infection statistics?
Authors: Allen C Cheng and Leon J Worth
Med J Aust 2014; 200 (5): 257-259. || doi: 10.5694/mja14.00101
Published online: 17 March 2014
Published online: 17 March 2014
However rates of Staphylococcus aureus bacteraemia are reported, the aim should be to reduce them
In reply: We thank Watson for her comments and agree that there is probably room for improvement. However, for most hospitals that fall within the funnel, rank is likely to reflect random variation. This contrasts with the common interpretation that rank reflects the quality of care.
We disagree with the interpretation of outliers. Noting that there are zero cases of Staphylococcus aureus bacteraemia (SAB) does not assist in determining whether hospitals are underreporting or are exemplar institutions. Although broad stratification by hospital grouping has been applied to formulate risk groups, both clinical and statistical heterogeneity is evident within each stratum, as we and the National Health Performance Authority have both noted.1-3
Additionally, the identification of “positive deviants” may be useful. For instance, we noted that Flinders Medical Centre had SAB rates below the funnel for both years. Consequently, we contacted its infection prevention unit for advice on how we might reduce infections at our own institution. A more comprehensive approach might be to report SAB rates along with the results of auditing and other relevant findings in outlier hospitals.
Competing interests
No relevant disclosures.
References
- Cheng AC, Woolnough E, Worth LJ, Pilcher DV. How should we interpret hospital infection statistics? Med J Aust 2013; 199: 735-736. CHDICDED
- Worth LJ, Thursky KA, Slavin MA. Public disclosure of health care-associated infections in Australia: quality improvement or parody [letter]? Med J Aust 2012; 197: 29. i1142861
- National Health Performance Authority. Hospital performance: healthcare-associated Staphylococcus aureus bloodstream infections in 2011–12, technical supplement. Sydney: NHPA, 2013. http://www.myhospitals.gov.au/publications/sab/latest/technical-supplement (accessed Feb 2014).