Safety and Quality > Our Work > Indicators of Safety and Quality > Core, Hospital-based Outcome Indicators

In November 2009, Health Ministers endorsed Commission’s recommendation that hospitals routinely monitor and review a succinct set of indicators.These hospital-based outcome indicators can be generated by jurisdictions or private hospital ownership groups, which hold the source data, and reported back to provider facilities. The safety and quality value lies in developing the report-review-act cycle based on the routine supply of timely and targeted data back to hospitals. A number of jurisdictions are already undertaking a similar process with many of the same indicators.

The core, hospital-based outcome indicators recommended for local generation and review are:

CHBOI 1 Hospital standardised mortality ratio (HSMR)

CHBOI 2 Death in low-mortality Diagnosis Related Groups (DRGs)

CHBOI 3 In-hospital mortality for:

a) acute myocardial infarction (AMI)
b) stroke
c) fractured neck of femur, and
d) pneumonia

CHBOI 4 Unplanned/unexpected hospital readmission of patients discharged following management of:

a) acute myocardial infarction (AMI)
b) knee replacements
c) hip replacements
d) paediatric tonsillectomy and adenoidectomy

CHBOI 5 Healthcare associated Staphylococcus aureus bacteraemia (SAB)

CHBOI 6 Clostridium difficile infection (CDI).

Updated in 2015, the National core hospital-based outcome indicators specification is available for download. The specification is complemented by the CHBOI Toolkit which is used for local generation of CHBOI. The toolkit includes SAS code, technical notes to accompany SAS code, nationally generated coefficients and reference sets.

The CHBOI Toolkit has not been validated and is designed as a screening tool for internal safety and quality improvement.  It is not intended to be used as a performance measure.

National core hospital-based outcome indicators specification (PDF 3MB)

To access the CHBOI toolkit please read the terms and conditions and complete the consent form. You will also be asked for your contact details which will be kept to inform you of future updates. The toolkit will be sent to your nominated email address.

For more information about the CHBOI toolkit please email

Hospital Mortality Indicator Literature Review

Melbourne Health has recently completed a literature review for the Commission. The Hospital Mortality Literature Review examines the usefulness and limitations of hospital mortality indicators. It is comprised of three parts, the body of the literature review, international case studies (Canada, United Kingdom, United States) and relevant appendices. The review focused on literature from 2010-2013.

Hospital Mortality Indicator Literature Review (PDF 831KB) (Word 563KB)
Hospital Mortality Indicator Case Studies (PDF 6.96MB) Part 1 (Word 11MB) Part 2 (Word 7MB)
Hospital Mortality Indicator Appendices (PDF 4.41MB) (Word 10MB)

A guide for Boards and Chief Executives on Hospital Mortality Indicators

To support local interpretation and use of hospital mortality indicators, the Commission has developed a publication Using hospital mortality indicators to improve patient care: A guide for Boards and Chief Executives (the Guide).

The Guide has been prepared for Boards and Chief Executives of hospitals and Local Hospital Networks (LHNs). It provides information on how hospital mortality indicators can be used to screen for potential safety and quality issues through existing clinical governance processes.

Using hospital mortality indicators to improve patient care: A guide for Boards and Chief Executives