A comparative analysis of hospital-acquired complications and sentinel event reporting across Australia, Canada, New Zealand, England, and the United States

Background

National health systems evaluate hospital safety and quality by incentivizing or mandating the reporting of both hospital-acquired complications (HACs), which are potentially preventable iatrogenic conditions, and sentinel events, which are potentially preventable but severely harmful incidents. Our objective was to describe the landscape of currently reported hospital quality measures across countries.

Methods

We compared HACs and sentinel events across five well-developed national reporting systems (Australia, Canada, New Zealand [NZ], England, and the United States [US]) and collated publicly reported rates and/or event counts. Reported measures were first categorized using existing Australian groupings with additional categories added by consensus.

Results

Per country, the number of unique HACs ranged from 7-43. The US, Australia, NZ, and Canada have measures in the categories of Pressure injuries, Falls and in hospital injuries, Healthcare-associated infections, and Thromboembolism. The United Kingdom England system reports aggregated counts under broader categories. Per country, the number of unique sentinel events ranged from 5-17 measures. “Unintended retention of a foreign body after a surgery” and “transfusion of incompatible blood” are a HAC, a sentinel event, or both depending on national definitions.

Conclusions

Hospital quality reporting varies considerably across countries which may complicate comparisons and sharing of successful improvement strategies. Targets for harmonization were identified.