Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/91801
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Type: Journal article
Title: Geographic variation of Failure-to-Rescue in public acute hospitals in New South Wales, Australia
Author: Assareh, H.
Ou, L.
Chen, J.
Hillman, K.
Flabouris, A.
Hollis, S.
Citation: PLoS One, 2014; 9(10):e109807-1-e109807-8
Publisher: Public Library of Science
Issue Date: 2014
ISSN: 1932-6203
1932-6203
Statement of
Responsibility: 
Hassan Assareh, Lixin Ou, Jack Chen, Kenneth Hillman, Arthas Flabouris, Stephanie J. Hollis
Abstract: Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002-2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.
Keywords: Humans
Postoperative Complications
Mortality
Risk
Geography
Time Factors
Local Government
Hospitals, Public
New South Wales
Rights: © 2014 Assareh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI: 10.1371/journal.pone.0109807
Grant ID: http://purl.org/au-research/grants/nhmrc/1009916
http://purl.org/au-research/grants/nhmrc/1020660
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