HACs FAQs and resources

A hospital-acquired complication (HAC) refers to a complication for which clinical risk mitigation strategies may reduce (but not necessarily eliminate) the risk of that complication occurring.

Many episodes with a HAC may not be preventable. However, HACs reporting is a safety and quality initiative aimed at monitoring and identifying potential areas for improvements in patient care. The work undertaken by the Commission in the development and review of the HACs list is to ensure these complications are monitored, and strategies implemented and evaluated where a need for change has been identified, as part of local level safety and quality improvement practices.

The HACs list was developed by a clinician-driven process to use existing administrative data for the purpose of patient safety and quality improvement. The following prioritisation criteria were used.

The development of the HACs list included:

• Clinical engagement and consultations
• Literature reviews
• Proof-of-concept testing with public and private hospitals

Further information on the development process

The Commission continually reviews the HACs list, please email sqis@safetyandquality.gov.au for further information.

Under the National Health Reform Agreement (NHRA) and subsequent Addendums, the incorporation of the HACs into the national public hospital funding model (for the Commonwealth’s contribution) was agreed to by all State, Territory and the Commonwealth governments in 2017.

For the Commonwealth’s contribution, the pricing signal and subsequent HACs funding adjustments are risk adjusted and updated annually, by the Independent Health and Aged Care Pricing Authority (IHACPA). The HACs risk adjustment methodology and funding adjustments are published by IHACPA as part of the annual National Efficient Price Determination and National Pricing Model Technical Specifications.

The IHACPA has published the Hospital Acquired Complications Fact Sheet, to provide additional advice on the safety and quality funding approaches.

The pricing signal is applied to reflect a proportion of the additional cost for care delivered associated with that complication. IHACPA’s case study example outlines how the HAC risk adjustment model is applied to an individual episode of care in terms of the National Efficient Price. The Commonwealth’s contributions to public hospital funding are determined by the National Health Funding Body (NHFB), and based on growth in activity between years. The HAC adjustment is incorporated in these growth calculations by the NHFB.

Non-Commonwealth funding adjustments relating to HACs, along with overall funding distributions to hospitals, are implemented, and incorporated differently across States, Territories and health services. Funding contributions can be calculated using activity based funding, block funding or a combination of both. Furthermore, clause A94 of the 2020-25 NHRA Addendum states:

There will be no requirement for Local Hospital Networks to be paid the full national efficient price if the State considers that a lower payment is appropriate, having regard to the actual cost of service delivery and the Local Hospital Network’s capacity to generate revenue from other sources.

For details on how your hospital or health service is impacted by HACs funding adjustments, please contact the appropriate unit within your health service, Local Health District or state and territory health department.

If the HAC is not documented, and therefore not coded, as part of the episode of care, this disadvantages a service in multiple ways.

The resources required to provide care to manage the HAC may not be captured in the funding formula, nor is there an explanation for any extended length of stay.

Discouraging documenting HACs is more likely to diminish funding streams than documenting the HAC will. Health services may be worse off from a funding perspective, let alone the medico-legal consequences of not documenting a patient’s diagnosis. 

As such, a health service is better off documenting the HAC to receive the greatest proportion of funding even if a small proportion is adjusted and potentially withheld.

Consistent and routine documentation and coding of HACs allows health services to monitor, target and improve the safety and quality of patient care. Overall, this results in better patient outcomes and improves financial efficiencies for health services (via increases in efficient activity, reducing the bed days and costs associated with treating HACs).

Examples of these potential efficiencies are illustrated in the report below:

One of the key markers and potential tools that should be used to support reviewing and interpreting HACs data, is the identification of variation in outcomes and results. This approach aligns with and is supported by NSQHS Standards (Action 1.28 - Variation in clinical practice and health outcomes). To support the review of variation the Commission has developed a User Guide for Reviewing Clinical Variation.

Variation can be masked when reviewing data at a whole of system level (for example, at a health service or facility level) and may only be visible with targeted integration. When reviewing HACs data within a facility, it is important to consider aspects such as patient demographics, Casemix, the structure of the facility and varying care type settings (such as acute versus subacute care).

To support the review and interpretation process, the HACs data may include looking at HAC numbers or rates, by patient age, sex and comorbidities, clinical specialty, or ward, for example. This process and interpretation should be supported by technical experts, clinicians and hospital managers within the service, to ensure the relevance and actionability of the HACs data produced.

When comparing HACs data between health services or facilities, it is imperative to consider differences between facilities, to provide context to any comparisons. This may involve comparing similar facilities (based on hospital peer groups, services provided and clinical specialties), appropriate risk adjustment or standardisation to cater for differing Casemix and patient populations.

Not all health services and jurisdictions have the ability, or ready access, to HAC data, from other services, to provide context to local results.

To support national comparisons of HAC rates the Commission has provided national and peer group rates for each HAC below, to support local level interpretation and quality improvement processes relating to HACs. 

Locally, nationally and internationally, various tools, resources and literature are available for health services to use and implement to mitigate and reduce HACs.

In Australia, there are resources produced by national bodies (such as the Commission, and various clinical bodies), jurisdictional level agencies (such as state policies and procedures) and local resources (policies and specialist clinicians).

The HACs resources and literature table below brings together the tools, resources and literature identified by the Commission in a literature review completed in early 2022. The Commission will endeavour to update this list as required, or when new evidence and resources become available.

HACs are highly burdensome, both to individual patients and the broader healthcare system. Any extended length of stay may have significant financial, social and/or personal implications for the patient, their families and health service organisations. When examining the rate of each HAC across peer hospitals with similar patient cohorts, it is clear there is significant variation. The Commission encourages all hospitals to work towards the rates achieved in the top quartile of peer facilities, as method introduced in the State of Patient Safety and Quality in Australian Hospitals 2019 report.

The table below details HAC goal rates for the three largest hospital peer groups. 

These rates are based on 2021-22 data and will be updated when new data becomes available.

The Commission is currently working on methodologies to provide data for smaller facilities and peer groups, and to provide a times series review of peer and goal rates.

^{n.p. indicates rates not published due to a small number of HACs, which may lead to unreliable and/or volatile results for interpretation.}

The information kit includes a suite of resources for clinicians, safety and quality professionals, managers and executives, governing bodies and others, to put in place strategies that reduce the occurrence of HACs. Monitoring HACs, and using strategies in the information kit to reduce the occurrence of HACs, can be used as evidence during accreditation against the National Safety and Quality Health Service Standards.

The HACs information kit includes three elements:

Download the full kit

Short Hospital-Acquired Complications Factsheets all HACs

2018

Publication, report or update

Individual HACs resources

Individual resources within the HACs information kit are provided below:

Hospital-Acquired Complication - 2. Falls resulting in fracture or intracranial injury fact sheet

2018

Guide, user guide or guidelines

• Hospital-Acquired Complication - 5. Unplanned intensive care unit admission - A fact sheet has not been prepared for HAC 5, which relates to ‘unplanned intensive care unit admission’. See the Introduction of the HACs information kit for further information.