Clinical incident data
Severity of Clinical Incidents
Clinical incidents notified in IIMS and Riskman are allocated a Severity Assessment Code (SAC) rating, while incidents reported in ims+ use the Harm Score. In line with the NSW Health Incident Management Policy, the SAC/Harm Score directs the level of investigation and action required for a given event.
The most serious types of clinical incidents are rated as SAC/Harm Score1 (the other possible scores are SAC/Harm Score2, SAC/Harm Score3 or SAC/Harm Score4 in declining order of severity). In ims+, the Harm Score is based on the incident outcome and additional care and/or resources that are needed as a result of the incident. The actual SAC/Harm Score must be confirmed by a manager within five days of the incident notification. All SAC/Harm Score1 incidents and National Sentinel Events (NSE) require a Reportable Incident Brief (RIB) to be submitted to the NSW Ministry of Health.
During the January – June 2020 reporting period, ims+ was in the process of being rolled out across NSW. Due to differences between IIMS and ims+ in relation to the classification of clinical incidents and complaints, data displayed within this report is limited to SAC/Harm Score rating of incidents and rates of clinical incidents and complaints in relation to hospital activity.
For the January – June 2020 period, the overall number of incidents decreased in line with reduced hospital activity as a result of the COVID-19 pandemic.
Most reported incidents (ninety-five per cent) were rated as SAC/Harm Score3 or SAC/Harm Score4 and resulted in minimal or no harm to the patient involved.
There has been a 10 per cent decrease in the overall number of clinical incident notifications across January – June 2020 compared to the previous reporting period. It is important to note the COVID-19 outbreak occurred during this reporting period and was declared a pandemic in March 2020. During the months of March and April 2020, NSW public hospitals suspended all non-urgent elective surgery procedures to effectively care for patients with COVID-19, and to preserve resources including personal protective equipment (PPE) for health workers.
In May 2020, a staged approach was implemented to re-commence elective surgery and restore hospital activity. The reduction of activity related to inpatient and outpatient services for non-urgent elective surgery during this time is considered to have contributed to the decrease in the overall number of clinical incident notifications between January and June 2020.
Table 1 shows that the number of incidents reported in the months of July to December are consistently higher than incidents reported during the months of January to June in each calendar year.
Table 1: Clinical Incidents notified by Actual SAC/Harm Score rating, July 2016 – June 2020
|Actual SAC/Harm Score Rating||2016||2017||2018||2019||2020|
|SAC/Harm Score 1*||261||248||232||255||279||272||283||246|
|SAC/Harm Score 2||1,417||1,446||1,619||1,603||1,774||1,615||1,654||1,508|
|SAC/Harm Score 3||43,086||43,405||44,764||43,842||48,471||49,193||50,222||41,844|
|SAC/Harm Score 4||46,819||46,210||49,486||48,321||51,893||51,285||53,494||51,684|
|No SAC/Harm Score Allocated||2,705||3,309||3,274||3,325||3,377||3,248||3,372||2,923|
Caveats: *SAC1 data obtained from CEC RIB database. SAC2-4 obtained from IIMS, ims+ and SVHN Riskman
Figure 2 and 3: Clinical SAC/Harm Score1 & SAC/Harm Score2 and SAC/Harm Score3 & SAC/Harm Score4 incident notifications, July 2016 – June 2020
Caveats: *SAC1 data obtained from CEC RIB database, SAC2-4 obtained from IIMS/ims+/SVHN Riskman
Clinical Incidents per 1,000 Acute Care Bed Days
Reporting the number of clinical incidents in relation to activity, i.e. per 1,000 acute care bed days, provides greater insight than reporting the number of incidents alone as it assists understanding of how common incidents are. The rate of SAC/Harm Score1 and SAC/Harm Score2 incidents from 2016 – 2020 has remained stable. SAC/Harm Score3 and SAC/Harm Score4 incidents that result in little or no harm are in line with the previous reporting period. The overall rate of incidents per 1,000 acute care bed days is slightly lower over January – June 2020 when compared with the previous reporting period.
Table 2: Clinical Incident notifications by SAC/Harm Score per 1,000 acute care bed days, July 2016 – June 2020
|Per 1,000 bed days||2016||2017||2018||2019||2020|
|SAC/Harm Score 1*||0.07||0.07||0.06||0.07||0.07||0.07||0.07||0.07|
|SAC/Harm Score 2||0.39||0.40||0.43||0.44||0.46||0.44||0.42||0.42|
|SAC/Harm Score 3||11.73||12.00||12.00||12.08||12.67||13.28||12.64||11.62|
|SAC/Harm Score 4||12.75||12.78||13.27||13.32||13.57||13.84||13.47||14.35|
|No SAC/Harm Score Allocated||0.74||0.91||0.88||0.92||0.88||0.88||0.85||0.81|
Caveats: SAC1 data obtained from CEC RIB database. SAC2-4 data obtained from IIMS, ims+ and SVHN Riskman
Figure 4 and Figure 5: SAC/Harm Score1 & SAC/Harm Score2 and SAC/Harm Score3 & SAC/Harm Score4 clinical incidents per 1,000 acute care bed days, July 2016 – June 2020