Strategic Objectives / Indicators

Health Directorate strategic indicators

Strategic Objective 1: Removals from Waiting List for Elective Surgery

In order to improve access to elective surgery, the ACT Government has committed to an increase in the number of elective surgery operations provided in the territory, and to reduce the number of people waiting more than the clinically recommended times for that surgery.

Strategic Indicator 1: The number of people removed from the ACT elective surgery waiting lists (This may include public patients treated in private hospitals)

 

2014–15 target

2014–15 result

People removed from the ACT elective surgery waiting list for surgery

12,000

11,875*

*Preliminary figure – subject to change

Source: ACT Health Elective Surgery published data set - July 2015

As shown in Figure 10, in 2014–15, ACT public hospitals performed 11,875 elective surgery procedures, a 1 per cent increase on the 11,780 reported for 2013–14. The result for 2014–15 is the highest number of elective surgeries performed within a single year.

 

Graph Number of elective surgeries performed

Figure 10: Number of elective surgeries performed

This is the fifth consecutive year that ACT Health has performed over 11,000 elective surgery procedures. Since 2002–03, when ACT Health provided a total of 7,661 elective surgery operations, there has been a 55 per cent increase in elective surgery activity, despite a 17 per cent increase in population since 2000–01.

As shown in Figure 11, ACT public hospitals recorded an increase in the number of patients waiting longer than the recommended timeframes for elective surgery in 2014–15, with 1,355 patients on the list at the end of June.

 

Graph - Number of patients waiting longer than recommended timeframes for elective surgery

Figure 11: Number of patients waiting longer than recommended timeframes for elective surgery

Despite the increases, ACT Health has still reduced the number of overdue patients over the last few years. When comparing the 1,355 patients waiting longer than the recommended timeframes at the end of June 2015 with the 2,220 patients waiting in June 2010, there has been a 39 per cent decrease in long wait patients.

Initiatives have been implemented to address the increase in long wait patients, including:

  • transferring some patients to the private sector, with no additional cost to the patient
  • increasing some surgery in public hospitals, for example, ear nose and throat surgery
  • improving partnerships with Southern NSW.

ACT Health is undertaking an in-depth analysis of elective surgery in the territory, with a focus on improving theatre utilisation and session allocation to more accurately reflect demand for specific specialty groups. We have built simulation models that predict the effect of changes to managing elective surgery. These findings will assist ACT Health in developing a surgical re-alignment strategy.

As shown in Figure 12, the median waiting time for access to elective surgery continues to improve, with a result of 45 days recorded for 2014–15, a decrease from 77 days four years ago. The ACT Health’s result of 45 days is still above the 2013–14 national average of 36 days. This demonstrates the improvement that ACT Health has made over recent years. ACT Health has reduced its long waiting patients over the last few years, which has reduced the median wait time to the lowest since 2002–03.

 

Graph - Median wait time for elective surgery in days

Figure 12: Median wait time for elective surgery in days

Hospital-Initiated Postponements (HIPs) measures how many patients have their elective surgery postponed. This performance indicator is useful for measuring the efficiency and effectiveness of the ACT’s elective surgery management. The most common reason for postponements occurring is lower acuity patients being substituted because another higher acuity patient is given priority.

ACT Health aims to ensure that less than 8 per cent of patients’ elective surgery is postponed. As shown in Figure 13, in 2014–15, ACT public hospitals achieved a result of 7 per cent, which compares favourably to the 9 per cent reported for 2010–11.

 

Graph - Hospital-Initiated Postponement rate

Figure 13: Hospital-Initiated Postponement rate

The ACT Health 2014–15 Annual Report presents some national elective surgery figures sourced from the National Hospital Performance Authority (NHPA). This information is reported by hospital peer group, which categories similar sized hospitals.

Table 5 shows comparisons between ACT public hospitals elective surgery timeliness by urgency category compared with other peer hospital groups.

It is widely recognised that there is inconsistency among jurisdictions within Australia in relation to the classifications of particular procedures and what urgency categories they should be. National agencies along with jurisdictions are working to better align with a national standard for categorisation of particular procedures, but until this work has been finalised caution should be exercised when considering comparability of these results.

Table 5: Proportion of patients admitted within their recommended timeframes for their awaited procedure (major metropolitan hospitals peer group)

Fin year

Canberra Hospital

Calvary Public Hospital

Peer group average

 

Urgency Category One (within 30 days)

Urgency Category Two (within 90 days)

Urgency Category Three (within 365 days)

Urgency Category One (within 30 days)

Urgency Category Two (within 90 days)

Urgency Category Three (within 365 days)

Urgency Category One (within 30 days)

Urgency Category Two (within 90 days)

Urgency Category Three (within 365 days)

2013–14

99%

72%

74%

97%

76%

94%

98%

79%

92%

2012–13

99%

64%

80%

97%

54%

95%

95%

76%

90%

2011–12

98%

50%

73%

97%

52%

92%

92%

76%

90%

Source: ACT Health Elective Surgery Waiting List Published Dataset and National Hospital Performance Authority (My Hospitals)

 

Strategic Objective 2: No Waiting for Access to Emergency Dental Health Services

This provides an indication of the responsiveness of the dental service to emergency clients.

Strategic Indicator 2: The percentage of assessed emergency clients seen within 24 hours

 

2014–15 target

2014–15 result

Percentage of assessed emergency clients seen within 24 hours

100%

100%

Source: ACT Health Dental published data – June 2015

Strategic Objective 2, for Canberra Hospital and Health Services is to ensure that 100 per cent of eligible clients triaged as a dental emergency are seen within 24 hours of contact to the service. The ACT Dental Health Program has continued to achieve this target throughout 2014–15.

Strategic Objective 3: Improving Timeliness of Access to Radiotherapy Services

This provides an indication of the effectiveness of public hospitals in meeting the need for cancer treatment services.

Strategic Indicator 3: The percentage of cancer patients who commence radiotherapy treatment within standard time frames

Category

2014–15 target

2014–15 result

Emergency — treatment starts within 48 hours

100%

100%

Palliative — treatment starts within 2 weeks

90%

95%

Radical — treatment starts within 4 weeks

90%

99%

Source: ACT Health Radiation Oncology published data (CAS) – July 2015

For 2014–15, radiotherapy performance measures and targets were revised to be in line with the National Radiation Oncology Practice Standards.

Radiation Oncology is committed to commencing treatment for radiation therapy patients within the waiting time guidelines specified in Radiation Oncology Practice Standards. In 2014–15, the department achieved the following:

  • Against a target of 90 per cent, 95 per cent of palliative patients received radiation therapy treatment within two weeks.
  • Against a target of 90 per cent, 99 per cent of radical patients received radiation therapy treatment within four weeks.

In 2014–15, 95 per cent of all radiotherapy patients were seen within standard waiting timeframes.

Table 6 provides comparative figures since 2011–12.

Table 6: Comparative timeframes for percentage of cancer patients who commence radiotherapy treatment within standard time frames

July to June

2011–12

2012–13

2013–14

2014–15

Emergency: within 48 hours

100%

100%

100%

100%

Palliative: with 2 weeks

100%

100%

100%

95%

Radical: within 4 weeks

94%

98%

100%

99%

Source: ACT Health Radiation Therapy Dataset

Strategic Objective 4: Improving the Breast Screen Participation Rate for Women aged 50 to 69 years

Strategic Indicator 4: The proportion of women aged 50 to 69 years who had a breast screen in the 24 months prior to each counting period

 

2014–15 target

2014–15 result

Proportion of women aged 50 to 69 who have a breast screen

60%

55%

Source: ACT Health BreastScreen published data (BIS) – July 2015

Despite ready availability of appointments, getting women to attend screening is proving challenging. A total of 15,566 breast screens were performed for ACT residents in 2014–15, compared with the 16,407 screening procedures reported for the same period in 2013–14.

The participation rate for women aged 50–69 years was 55 per cent.

BreastScreen ACT achieved the target for the total number of screens and exceeded the participation target for women aged 70–74 years.

To improve numbers, BreastScreen ACT has commenced an active recruitment campaign using multiple strategies, such as contacting lapsed attendees and sending letters to GPs to encourage women to have a breast screen.

More information: For detailed information, see BreastScreen Australia Program.

Strategic Objective 5: Maintaining the waiting times for in hospital assessments by the Aged Care Assessment Team

Strategic Indicator 5: Aged care assessment waiting time

 

2014–15 target

2014–15 result

Mean waiting time in working days

2 days

2 days

Source: ACT Health Admitted Patient Care published data – July 2015

During 2014–15, the Aged Care Assessment Team (ACAT) continued to manage client referrals and assess clients in a timely manner. ACAT has met ACT Health requirements to respond to public hospital-based assessments within the target of two working days of acceptance of referral.

Strategic Objective 6: Reducing the Usage of Seclusion in Mental Health Episodes

This measures the effectiveness of public mental health services in the ACT over time in providing services that minimise the need for seclusion.

Strategic Indicator 6: The proportion of mental health clients who are subject to a seclusion episode while being an admitted patient in an ACT public mental health inpatient unit

 

2014–15 target

2014–15 result

The proportion of mental health clients who are subject to a seclusion episode while being an admitted patient in an ACT public mental health inpatient unit

<3%

5%

Source: ACT Health Mental Health published data (MHAGIC) – July 2015

Mental Health, Justice Health, Alcohol and Drug Services is a national leader in reducing seclusion and restraint rates in mental health inpatient settings. During the 2015 National Seclusion and Restraint Forum the national rates of seclusion were a focus. Nationally, the highest rates of seclusion occur in adult mental health units.

As shown in Table 7, in 2014–15, the ACT seclusion result was 2 per cent above our local target of 3 per cent and an increase when compared to previous year’s results.

Table 7: Change in seclusion results

ACT public hospitals – Mental Health Seclusion Rates

2012–13

2013–14

2014–15

2%

2%

5%

 

Source: ACT Health Admitted Patient Care Published Dataset and MHAGIC Database

Reducing seclusion remains a high priority for the staff in the Adult Mental Health Unit. The higher rate of seclusion during 2014–15 was due to a very high level of clinical acuity in the Adult Mental Health Unit at Canberra Hospital in December 2014 and January 2015.

The weekly seclusion review meetings continue to occur. Implementing the Aggression and Violence clinical guidelines will provide further support to staff in the early identification and management of aggression and violence. A new training program for the Early Support and Intervention Team in the Adult Mental Health Unit (AMHU) with updated procedures and protocols will contribute to reducing episodes of seclusion.

Based on a former counting methodology, the target for the percentage of inpatients contacted within seven days post-discharge indicator was increased from 75 per cent in 2013–14 to 85 per cent in 2014–15. The ACT’s result for this indicator in 2014–15 was 72 per cent.

The most recent national publication released by the Productivity Commission is the Report on Government Services (RoGS) 2015, which examines each jurisdiction’s post-discharge follow-up performance for 2012–13. As shown in Figure 14, the national rate is 61 per cent. While the ACT’s result of 72 per cent is below the target, it is the highest rate of patient follow-up seven days post-discharge in Australia.

 

Graph - Mental health seven days post-discharge follow-up rates for 2012–13 by jurisdiction

Figure 14: Mental health seven days post-discharge follow-up rates for 2012–13 by jurisdiction

The unplanned re-admission rate for 2014–15 has improved to 6 per cent when compared to 2013–14. It is known that community follow-up by mental health services, carer involvement and other community supports are key factors in reducing re-admissions within 28 days of an initial inpatient admission.

Table 8: ACT Public Hospitals 28 Day Re-admissions for Mental Health patients

Financial year

Percentage of ACT Public Hospitals 28 day re-admissions for mental health patients

2012–13

10%

2013–14

7%

2014–15

6%

Source: ACT Health Admitted Patient Care Published Dataset and MHAGIC Database

Strategic Objective 7: Maintaining Reduced Rates of Patient Return to an ACT Public Acute Psychiatric Inpatient Unit

This indicator reflects the quality of care provided to acute mental health patients.

Strategic Indicator 7: The proportion of clients who return to hospital within 28 days of discharge from an ACT public acute psychiatric unit following an acute episode of care

 

2014–15 target

2014–15 result

Proportion of clients who return to hospital within 28 days of discharge from an ACT acute psychiatric mental health inpatient unit

<10%

6%

Source: ACT Health Mental Health published data (MHAGIC) – July 2015

Strategic Objective 8: Reaching the Optimum Occupancy Rate for all Overnight Hospital Beds

This provides an indication of the efficient use of resources available for hospital services.

Strategic Indicator 8: The mean percentage of overnight hospital beds in use

 

2014–15 target

2014–15 result

Mean percentage of overnight hospital beds in use

90%

85%

Source: ACT Health Admitted Patient Care published data – July 2015

As shown in Table 9, in 2014–5, ACT public hospitals reported a combined occupancy rate of 85 per cent, a 5 per cent improvement when compared to 90 per cent reported in 2013–14. This is a positive improvement as the demand for beds:

  • increased in 2014–15
  • is directly related to the additional beds that have been injected into ACT public hospitals.

Table 9: Mean percentage of overnight hospital beds in use

ACT public hospital

Mean percentage of overnight hospital beds in use

Canberra Hospital

88%

Calvary Public Hospital

78%

ACT Public Hospitals Combined Result

85%

2014–15 Target

90%

Source: ACT Health Admitted Patient Care Dataset

In 2014–15, there were a total of 100,785 inpatient episodes of care (separations) in ACT public hospitals. This consisted of:

  • 53,457 same day patients
  • 47,329 overnight patients who stayed one or more nights in hospital.

Overall, the number of separations increased by 4 per cent when compared with 96,969 separations reported for 2013–14.

ACT public hospitals provided 290,621 overnight hospital bed days of care in 2014–15, which is:

  • a 3 per cent increase on the reported 2013–14 result of 280,939
  • a 17 per cent increase on the reported 2009–10 result of 249,046.

Figure 15 shows the number of overnight bed days and overnight separations.

 

Graph - Overnight bed days of care versus overnight separations

Figure 15: Overnight bed days of care versus overnight separations

As shown in Table 10, the average length of stay for overnight patients in ACT public hospitals in 2014–15 was 6.2 days. This is a slight reduction when compared to the 6.3 days reported for 2013–14. The result for 2014–15 is still above the 2013–14 national average of 5.5 days.

Table 10: Average length of stay in hospital for overnight patients

 Year

Canberra Hospital

Calvary Public Hospital

ACT public hospitals

National average

2012–13

6.2 days

6.3 days

6.3 days

4.9 days

2013–14

6.3 days

6.3 days

6.3 days

5.5 days

2014–15

6.4 days

5.7 days

6.2 days

N/A

Source: ACT Health Admitted Patient Care Dataset and Australian Institute of Health & Welfare

Strategic Objective 9: Management of Chronic Disease: Maintenance of the Highest Life Expectancy at Birth in Australia

Australians are living longer and gains in life expectancy are continuing. Premature deaths (those of people aged under 75 years) from leading potentially preventable chronic diseases have decreased over time. In 2007, a person was 17 per cent less like to die prematurely from a chronic disease than in 1997.

Life expectancy at birth provides an indication of the general health of the population and reflects on a range of issues other than the provision of health services, such as economic and environmental factors. The ACT continues to enjoy the highest life expectancy of any jurisdiction in Australia and the Government aims to maintain this result.

Strategic Indicator 9: Life expectancy at birth in Australia 2013

 

ACT rate (years)

National rate (years)

Females

85.0

84.3

Males

81.7

80.1

Source: ABS 2013, Deaths, Australia, 2013, cat. no. 3302.0, ABS, Canberra.

The ACT remains the jurisdiction with the highest life expectancy in Australia. Over the 10 year period from 2004 to 2013, life expectancy in the ACT increased by two years for males and 1.1 years for females.

Cancer and cardiovascular disease are the leading contributors to the total burden of disease in the ACT, contributing nearly half of the total disease burden.

Strategic Objective 10: Lower Prevalence of Circulatory Disease than the National Average

Population projections suggest that the ACT population is ageing faster than other jurisdictions, however the population is still younger than the national average, having a median age of 34.9 years in 2014 compared with 37.3 years. While people of all ages can present with a chronic disease, the ageing of the population and longer life spans mean that chronic diseases will place major demands on the health system for workforce and financial resources.

Strategic Indicator 10: Proportion of the ACT Population with Some Form of Cardiovascular Disease, 2011–12

 

ACT rate

National rate

Proportion of the population diagnosed with some form of cardiovascular disease

18.4%

16.9%

Source: Australian Health Survey: First Results, 2011–12. Australian Bureau of Statistics Catalogue No: 4364.0.55.001.

Strategic Objective 11: Lower Prevalence of Diabetes than the National Average

This indicator provides a marker of the success of prevention and early intervention initiatives. The self-reported prevalence of diabetes in Australia has more than doubled over the past 25 years. A number of factors may have contributed to this, such as changed criteria for the diagnosis of diabetes, increased public awareness and an increase in the prevalence of risk factors such as obesity and sedentary behaviour. Prevalence rates may also increase in the short-term as a result of early intervention and detection campaigns. This would be a positive result as undiagnosed diabetes can have significant impacts on long-term health. The prevalence of diabetes in the ACT is similar to the national rate.

Strategic Indicator 11: Age standardised proportion of the ACT Population Diagnosed with Some Form of Diabetes

 

ACT rate

National rate

Prevalence of diabetes in the ACT

3.8%

3.7%

Source: Australian Health Survey: First Results, 2011–12. Australian Bureau of Statistics Catalogue No: 4364.0.55.001.

Strategic Objective 12: Government capital expenditure on healthcare infrastructure

This indicator provides information on government investment to improve healthcare infrastructure. Information on the level of funding allocated for health infrastructure as a proportion of overall expenditure provides an indication of investment towards developing sustainable and improved models of care. The aim for the ACT is to exceed the national rate of expenditure on infrastructure.

Strategic Indicator 12: Capital consumption

Government capital expenditure as a proportion of government capital consumption expenditure by healthcare facilities, 2008–09 to 2010–11

ACT rate

National rate

2008–09

2.76

1.90

2009–10

2.67

1.57

2010–11

3.84

2.15

Source: Health Expenditure Australia 2010–11 (Australian Institute of Health and Welfare). This report is released every two years and presents historical data.

Strategic Objective 13: Higher proportion of Government recurrent health funding expenditure on public health activities than the national average

Improvements in the prevention of diseases can reduce longer term impacts on the health system, particularly for people with chronic diseases. The aim for the ACT is to exceed the Australian average rate of recurrent health funding on public health activities as a strategy to reduce the long-term chronic disease burden.

Strategic Indicator 13: Proportion of Government recurrent health funding expenditure on public health activities

Estimated total government expenditure on public health activities as a proportion of total current health expenditure

ACT rate

National rate

2008–09

3.1%

2.7%

2009–10

2.7%

2.2%

2010–11

2.6%

2.1%

Source: Health Expenditure Australia 2010–11 (Australian Institute of Health and Welfare).

Strategic Objective 14: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status

The immunisation rate provides an indication of the level of investment in public health services to minimise the incidence of vaccine preventable diseases. The ACT’s Aboriginal and Torres Strait Islander population has a lower rate of immunisation than the general population at 24–27 months. The rates of immunisation coverage for Aboriginal and Torres Strait Islander children at 12–15 months is equal to the general population and higher than the general population for children at 60–63 months. The ACT aims to increase immunisation coverage rates for all Aboriginal and Torres Strait Islander children through a targeted immunisation strategy.

Strategic Indicator 14: Immunisation Rates – ACT Aboriginal and Torres Strait Islander Population

Immunisation rates for vaccines in the national schedule for the ACT indigenous population:

2014–15 target

2014–15 result

12 to 15 months

≥90%

92.9%

24 to 27 months

≥90%

84.3%

60 to 63 months

≥90%

94.3%

All

≥90%

90.5%

During 2014–15, vaccination coverage rates for Aboriginal and Torres Strait Islander children in the ACT within two of the three cohorts were the highest in Australia. However, the very low numbers of Aboriginal and Torres Strait Islander children in the ACT means that ACT Aboriginal and Torres Strait Islander coverage data should be read with caution, as the immunisation coverage rates can fluctuate greatly. Coverage rates can vary dramatically between cohorts and between reporting periods.

Strategic Objective 15: Higher Participation Rate in the Cervical Screening Program than the National Average

The two-year participation rate provides an indication of the effectiveness of early intervention health messages. The ACT aims to continue to exceed the national average for this indicator.

Strategic Indicator 15: Two Year Participation Rate in the Cervical Screening Program

 

ACT rate

National rate

Two year participation rate

57.9%

57.8%

Source: Cervical Screening in Australia 2013–14 (Published: Australian Institute of Health and Welfare, June 2015).

The Cervical Screening Program captures and reports data over a two-year period as recommended by the National Cervical Screening Program. The AIHW report, Cervical Screening in Australia 2013–2014, puts the ACT in the top three jurisdictions in Australia for participation in cervical screening and first overall in Australia for the five-year participation rate.

Strategic Objective 16: Achieve Lower than the Australian Average in the Decayed, Missing, or Filled Teeth (DMFT) Index

This gives an indication of the effectiveness of dental prevention, early intervention and treatment services in the ACT. The aim for the ACT is to be lower than the national average on the DMFT index.

Strategic Indicator 16: The Mean Number of Teeth with Dental Decay, Missing or Filled Teeth at Ages 6 and 12

 

ACT rate

National rate

DMFT index at 6 years

1.03

2.13

DMFT Index at 12 years

0.70

1.05

Source: Child Dental Health Survey, 2009 (Published: Australian Institute of Health and Welfare, 2013).

Strategic Objective 17: Reducing the Risk of Fractured Femurs in ACT Residents Aged Over 75 years

This indicator provides an indication of the success of public and community health initiatives to prevent hip fractures. In 2013–14, the ACT rate of admissions in persons aged 75 years and over with a fractured neck of femur was 6.7 per 1,000 persons in the ACT population.

Strategic Indicator 17: Reduction in the Rate of Broken Hips (Fractured Neck of Femur) for those aged over 75 years

 

2013–14 result

Long-term target

Rate per 1,000 people

6.7

5.3

 

Source: ACT Health Admitted Patient Care data, 2013–14.

Strategic Objective 18: Reduction in the Youth Smoking Rate

Results from the 2011 Australian Secondary School Alcohol and Drug Survey (ASSAD) show that 5.8 per cent of students were current smokers in that year. This represents a significant decline in current smoking from 20.5 per cent of students in 1999.

The proportion of ACT students reporting to be current smokers in 2011 is slightly lower than the national average of 6.7 per cent.

Strategic Indicator 18: Percentage of Persons Aged 12 to 17 Years Who Smoke Regularly

 

2011 outcome

National rate

Percentage of persons aged 12 to17 who are current smokers

5.8%

6.7%

Source: ASSAD confidentialised unit record files 2011, ACT Health. Australian secondary students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011 report, The Cancer Council Victoria, December 2012.

ACT Local Hospital Network strategic objectives and indicators

Strategic Objectives and Indicators

The ACT Local Hospital Network (ACT LHN) consists of a networked system that includes the Canberra Hospital and Health Services, Calvary Public Hospital, Clare Holland House and Queen Elizabeth II Family Centre. The ACT LHN has a yearly Service Level Agreement (SLA) which sets out the delivery of public hospital services and is agreed between the ACT Minister for Health and the Director General of the ACT LHN. This SLA identifies the funding and activity to be delivered by the ACT LHN and key performance priority targets. The ACT Government manages system-wide public hospital service delivery, planning and performance, including the purchasing of public hospital services and capital planning, and is responsible for the management of the ACT LHN.

The following strategic indicators include some of the major performance indicators implemented under the requirements of the National Health Reform Agreement.

Strategic Objective 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency

Strategic Indicator 1: Percentage of Elective Surgery Cases Admitted on Time by Clinical Urgency

Clinically recommended time by urgency category

2014–15 target

2014–15 result

Urgent – admission within 30 days is desirable for a condition that has the potential to deteriorate quickly to the point that it may become an emergency

100%

95%

Semi-urgent – admission within 90 days is desirable for a condition causing some pain, dysfunction or disability which is not likely to deteriorate quickly or become an emergency

78%

69%

Non-urgent – admission at some time in the future acceptable for a condition causing minimal or no pain, dysfunction or disability, which is not likely to deteriorate quickly and which does not have the potential to become an emergency

91%

83%

Source: ACT Health Elective Surgery published data – July 2015

Strategic Objective 2: Improved Emergency Department Timeliness

Access to emergency care is a major priority for the ACT Government. ACT Health is committed to improving waiting times in the Emergency Departments and continues to provide services to the Canberra community while ongoing work into new initiatives and investments occurs.

Strategic Indicator 2.1

Strategic Indicator 2.1: The proportion of Emergency Department presentations that are treated within clinically appropriate timeframes

Triage category

2014–15 target

2014–15 result

One (resuscitation seen immediately)

100%

100%

Two (emergency seen within 10 minutes)

80%

78%

Three (urgent seen within 30 minutes)

75%

48%

Four (semi-urgent seen within 60 minutes)

70%

53%

Five (non-urgent seen within 120 minutes)

70%

86%

All Presentations

70%

59%

Source: ACT Health Emergency Department published data – July 2015

The 3 per cent increase in demand experienced in 2014–15 was a major reason for some performance indicators underachieving against targets. This was evident for Emergency Department timeliness, where ACT public hospitals recorded results below last year’s overall timeliness figures.

Emergency Department timeliness measures how long patients wait to receive their care. In 2014–15, ACT public hospital Emergency Departments reported an overall timeliness result of 59 per cent, 2 per cent below the result reported in 2013–14.

Table 11 shows the percentage of patients seen on time by triage category in 2014–15. The 3 per cent increase in presentations experienced in 2014–15 affected on the ability to treat all patients within recommended timeframes. This led to longer waiting times for some lower acuity patients. The ACT met the target for triage category one and category two.

Table 11: Patients seen on time by triage category in 2014–15

Triage category

2014–15 target

ACT Public Hospitals combined 2014–15 results

Canberra Hospital 2014–15 results

Calvary Public Hospital 2014–15 results

National average 2013–14 results

Category 1 (resuscitation – seen immediately)

100%

100%

100%

100%

100%

Category 2 (emergency – seen within 10 minutes)

80%

78%

77%

81%

82%

Category 3 (urgent – seen within 30 minutes)

75%

48%

39%

59%

70%

Category 4 (semi-urgent – seen within 60 minutes)

70%

53%

43%

66%

75%

Category 5 (non-urgent – seen within 120 minutes)

70%

86%

80%

92%

92%

All presentations

70%

59%

51%

69%

75%

Source: ACT Health Emergency Department Published Dataset and Australian Institute of Health & Welfare

The AIHW notes in their Emergency Department Care 2013-14 report that the ACT had the highest growth rate of any jurisdiction in terms of presentations to the Emergency Departments in 2013–14. When simply comparing presentations, from 2012–13 to 2013–14, there was a 6 per cent increase in people seeking treatment in 12 months. This equates to an average of 345 people attending the public hospital Emergency Departments each day.

Table 12 provides a further breakdown of national comparative figures for the major metropolitan hospital peer group over recent financial years for percentage of presentations seen on time.

 

Table 12: Yearly comparison of patients seen on time by triage category

Fin Year

Canberra Hospital

Calvary Public Hospital

Peer group average

Triage 1

Triage 2

Triage 3

Triage 4

Triage 5

Triage 1

Triage 2

Triage 3

Triage 4

Triage 5

Triage 1

Triage 2

Triage 3

Triage 4

Triage 5

2013–14

99%

80%

42%

49%

81%

100%

89%

60%

67%

91%

100%

80%

66%

73%

91%

2012–13

100%

70%

34%

39%

74%

99%

82%

52%

54%

85%

100%

81%

64%

70%

89%

2011–12

100%

73%

43%

45%

78%

100%

81%

57%

51%

83%

100%

80%

62%

68%

88%

2010–11

99%

78%

38%

38%

70%

100%

78%

59%

58%

81%

100%

78%

61%

66%

86%

Source: ACT Health Emergency Department Published Dataset and National Hospital Performance Authority (My Hospitals)

 

Table 13 shows the median waiting times for patients to be seen from when they first present to an ACT public hospital Emergency Department to when treatment first commences. Over the past two years ACT public hospitals have made improvements in the median waiting time to be seen, particularly for triage category three and four presentations.

Table 13: Waiting time between earliest event in episode and seen time

Waiting time between earliest event in episode and seen time

Triage category

Resuscitation - Immediate within seconds

Emergency <= 10 mins

Urgent <= 30 mins

Semi-urgent <= 60 mins

Non-Urgent <= 120 mins

Total

Median

Median

Median

Median

Median

Median

2014–15

0:00:00

0:05:00

0:33:00

0:55:00

0:42:00

0:37:00

2013–14

0:00:00

0:04:00

0:30:00

0:50:00

0:37:00

0:33:00

2012–13

0:00:00

0:06:00

0:41:00

1:08:00

0:50:00

0:44:00

Source: ACT Health Emergency Department Published Dataset

 

Strategic Indicator 2.2

Strategic Indicator 2.2: The proportion of Emergency Department presentations whose length of stay in the Emergency Department is four hours or less

 

2014–15 target

2014–15 result

The proportion of Emergency Department presentations who either physically leave the Emergency Department for admission to hospital, are referred for treatment or are discharged, whose total time in the Emergency Department is within four hours.

77%

63%

Source: ACT Health Emergency Department published data – July 2015

As shown in Table 14, in 2014–15, ACT public hospital Emergency Departments continued to improve the proportion of patients who presented to Emergency Departments who stayed less than four hours from their arrival to either admission or their departure home. The result was 63 per cent, which is a 1 per cent improvement when compared to 2013–14, and a 5 per cent improvement when compared with the 58 per cent reported for 2011–12.

Table 14: Four hour rule ACT vs. Australia

Financial year

ACT performance

National average

2011–12

58%

64%

2012–13

57%

67%

2013–14

62%

73%

2014–15

63%

N/A

Source: ACT Health Emergency Department Published Dataset and Australian Institute of Health & Welfare

As shown in Table 15, ACT public hospitals compare more favourably in this measure to the peer group average.

Table 15: Four hour rule ACT Public Hospitals against their peer group average

Financial year

Canberra Hospital

Calvary Public Hospital

Peer group average

2013–14

56%

69%

66%

2012–13

52%

64%

58%

2011–12

54%

63%

54%

Source: ACT Health Emergency Department Published Dataset and National Hospital Performance Authority (My Hospitals)

In 2014–15, the proportion of patients who Did Not Wait (DNW) for treatment was 5 per cent. This is comparable with the result reported for 2013–14 and better than the 10 per cent reported in 2010–11. The result for 2014–15 is under the ACT target, which is set at 10 per cent.

 

Graph - Did Not Wait for treatment rates

Figure 16: Did Not Wait for treatment rates

Strategic Objective 3: Maximising the Quality of Hospital Services

The following four indicators are a selection of the patient safety and service quality indicators that are used to monitor ACT public hospital services. The targets provide an indication of the desired outcomes over time. Given the nature of the indicators, small fluctuations during a particular period can skew results. The success in meeting these indicators requires a consideration of performance over time rather than for any given period.

This indicator represents the quality of theatre and postoperative care.

Strategic Indicator 3.1

Strategic Indicator 3.1: The Proportion of People who Undergo a Surgical Operation Requiring an Unplanned Return to the Operating Theatre within a Single Episode of Care due to Complications of their Primary Condition

 

2014–15 target

2014–15 result

Canberra Hospital

<1.0%

0.80%

Calvary Public Hospital

<0.5%

0.23%

Source: Data obtained by screening individual medical records of patients from ACTPAS reports against the ACHS definitions for these indicators.

As shown in Figure 17, in 2014–15, preliminary results suggest Calvary Public Hospital reported:

  • positive results in the proportion of people who require an Unplanned Return To the Operating Theatre (URTOT) during their hospital stay when compared to 2013–14

  • was below its target, which is set at 0.50 per cent.

Also as shown in Figure 17, preliminary figures suggest Canberra Hospital reported an increase in 2014–15 when compared to previous years. However, this result is below the target, which is set at 1 per cent. Canberra Hospital is a major teaching and referral hospital that manages more complex patients and higher levels of complications.

 

Graph - Unplanned return to the operating theatre within an episode of care

Figure 17: Unplanned return to the operating theatre within an episode of care

Strategic Indicator 3.2

Strategic Indicator 3.2: The Proportion of People Separated from ACT public hospitals who are re-admitted to Hospital within 28 Days of their Separation due to Complications of their Condition (where the re-admission was unforeseen at the time of separation).

This indicator highlights the effectiveness of hospital-based and community services in the ACT in the treatment of persons who receive hospital-based care.

 

2014–15 target

2014–15 result

Canberra Hospital

<2.0%

1.21%

Calvary Public Hospital

<1.0%

0.53%

Source: Data obtained by screening individual medical records of patients from ACTPAS reports against the ACHS definitions for these indicators.

As shown in Figure 18, in 2014–15, preliminary figures suggest ACT public hospitals continue to report good results for the proportion of people who return to hospital within 28 days of discharge. The results at Canberra Hospital and Calvary Public Hospital remained below the targets during 2014–15.

 

Graph - Rate of unplanned hospital admissions within 28 days of discharge

Figure 18: Rate of unplanned hospital admissions within 28 days of discharge

Strategic Indicator 3.3

Strategic Indicator 3.3: The Number of People Admitted to Hospitals per 10,000 Occupied Bed Days who Acquire a Staphylococcus Aureus Bacteraemia Infection (SAB infection) During their Stay

This provides an indication of the safety of hospital-based services.

 

2014–15 target

2014–15 result

Canberra Hospital

<2 per 10,000

1.00 per 10,000

Calvary Public Hospital

<2 per 10,000

0.32 per 10,000

Source: ACT Health Infection Control database

This indicator has changed based on the national quality and safety standards. It now measures the number of people admitted to hospitals per 10,000 occupied bed days who acquire a SAB infection during their hospital stay.

ACT Health infection control officers continue to develop and implement programs and processes to limit the transfer of infections within public hospitals. This includes providing communication and education programs for clinicians, patients, general staff and visitors. In addition, both ACT public hospitals maintain processes to minimise hospital-acquired infections during hospital stays.

As noted previously, the targets for each hospital are based on the types of services provided. As the major trauma hospital for the region, Canberra Hospital has higher SAB infection rates than Calvary Public Hospital.

As shown in Table 16, Canberra Hospital reported a positive SAB rate result of 1.00 cases per 10,000 bed days in 2014–15, which is an improvement on the 1.05 cases reported for 2013–14.

 

Table 16: Canberra Hospital vs. National SAB Rates Peer Group 1 (Major metropolitan hospital – principal referral centre)

Financial year

Canberra Hospital

National peer group average

Target

2014–15

1.00

N/A

2.00

2013–14

1.05

1.28

2.00

2012–13

1.55

1.35

2.00

Source: ACT Health Admitted Patient Care Dataset, ACTPAS and National Hospital Performance Authority (My Hospitals)

As shown in Table 17, Calvary Public Hospital reported a SAB rate of 0.32 cases per 10,000 bed days in 2014–15, compared with the 0.33 result recorded in 2013–14.

Calvary public hospital reported low results for SAB rates in 2013–14 compared to their peer hospitals in the major hospitals with fewer vulnerable patients category. Calvary public hospital reported a result of 0.33 cases per 10,000 patient bed days against the peer group average of 0.78 cases per 10,000 patient bed days.

 

Table 17: Calvary Public Hospital vs. National SAB Rates Peer Group 2 (Major metropolitan hospital – public acute group A hospitals)

Financial year

Calvary Public Hospital

National peer group average

Target

2014–15

0.32

N/A

2.00

2013–14

0.33

0.78

2.00

2012–13

0.32

0.91

2.00

Source: ACT Health Admitted Patient Care Dataset, ACTPAS and National Hospital Performance Authority (My Hospitals)

These results are below the national benchmark of 2.00 cases per 10,000 bed days of care. Furthermore, recent national figures illustrated in Table 16 and Table 17 show both public hospitals remain below the national average for their respective hospital categories or peer groups.

On 9 April 2015, the National Health Performance Authority (NHPA) released its latest report titled Healthcare-associated Staphylococcus aureus bloodstream infection in 2013–14.

The report highlighted that in 2013–14, major peer group hospitals with more vulnerable patients had an average result of 1.28 cases per 10,000 patient bed days. For that same period, Canberra Hospital reported a result of 1.05 cases per 10,000 patient bed days, which is:

  • below the peer group average

  • a decrease compared to the result reported for 2012–13 of 1.55 cases per 10,000 patient days.

Strategic Indicator 3.4

Strategic Indicator 3.4: The Estimated Hand Hygiene Rate

The estimated hand hygiene rate for a hospital is a measure of how often (as a percentage) hand hygiene is correctly performed.

It is calculated by dividing the number of observed hand hygiene 'moments' where proper hand hygiene was practiced in a specified audit period, by the total number of observed hand hygiene 'moments' in the same audit period.

 

2014–15 target

2014–15 result

Canberra Hospital

70%

79%

Calvary Public Hospital

70%

77%

Source: Hand Hygiene Australia online database

As shown in Table 18, Canberra and Calvary public hospitals continued to improve on the national benchmark of 70 per cent during the most recent audit, which was undertaken in March 2015.

Table 18: Estimated hand hygiene rate

 

Canberra Hospital

Calvary Public Hospital

National benchmark

70%

70%

2014 March audit

73%

82%

2014 June audit

74%

83%

2014 October audit

76%

73%

2015 March audit

79%

77%

Source: ACT Health Admitted Patient Care Dataset, ACTPAS and National Hospital Performance Authority (My Hospitals)