Safety and Quality > Our Work > Indicators of Safety and Quality > Hospital-acquired complications

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.  The national list of 16 HACs was developed through a comprehensive process that included reviews of the literature, clinical engagement and testing of the concept with public and private hospitals. For more information about this process, see ‘development of this HACs list’.

The Commission has developed a range of resources to support adoption of the HACs list and improve patient safety and healthcare quality. These include:

These resources support health services to monitor HACs, and also put in place strategies to either reduce high rates of HACs, or maintain low HACs rates. These resources, and the focus of the HACs, recognise that HACs affect patients, their families and the healthcare system. The HACs list offers 16 agreed, high-priority complications which clinicians, managers and others can work together to address and improve patient care.

The hospital-acquired complications list



Pressure injury
  • Stage III ulcer
  • Stage IV ulcer
  • Unspecified decubitus ulcer and pressure area
Falls resulting in fracture or intracranial injury
  • Intracranial injury
  • Fractured neck of femur
  • Other fractures
Healthcare-associated infection
  • Urinary tract infection
  • Surgical site infection
  • Pneumonia
  • Blood stream infection
  • Central line and peripheral line associated bloodstream infection
  • Multi-resistant organism
  • Infection associated with prosthetics/implantable devices
  • Gastrointestinal infections
Surgical complications requiring unplanned return to theatre
  • Post-operative haemorrhage/haematoma requiring transfusion and/or return to theatre
  • Surgical wound dehiscence
  • Anastomotic leak
  • Vascular graft failure
  • Other surgical complications requiring unplanned return to theatre

Unplanned intensive care unit admission

  • Unplanned admission to intensive care unit
Respiratory complications
  • Respiratory failure including acute respiratory distress syndrome requiring ventilation
  • Aspiration pneumonia
Venous thromboembolism
  • Pulmonary embolism
  • Deep vein thrombosis
Renal failure
  • Renal failure requiring haemodialysis or continuous veno-venous haemodialysis
Gastrointestinal bleeding
  • Gastrointestinal bleeding
Medication complications
  • Drug related respiratory complications/depression
  • Haemorrhagic disorder due to circulating anticoagulants
  • Hypoglycaemia
  • Delirium
Persistent incontinence
  • Urinary incontinence
  • Malnutrition
Cardiac complications
  • Heart failure and pulmonary oedema
  • Arrhythmias
  • Cardiac arrest
  • Acute coronary syndrome including unstable angina, STEMI and NSTEMI
Third and fourth degree perineal laceration during delivery
  • Third and fourth degree perineal laceration during delivery
Neonatal birth trauma
  • Neonatal birth trauma



Specifications and grouper

The specifications for the HACs list provide the codes, inclusions and exclusions required to calculate HACs rates. The specifications are provided in the 7th to 10th editions of the ICD-10-AM. The HACs list and specifications will be reviewed regularly.

This process began in July 2018.  In August 2018, the specifications were updated to include mental health patients (Version 1.1). Version 1 will continue to be used for pricing in 2018-19.

To provide feedback on the HACs list, please email Feedback will be considered by the HACs Curation Clinical Advisory Group as a part of the review.

Download the specifications for the HACs list here.

The Commission and IHPA have developed excel and SAS tools (also known as groupers). The groupers can be used by hospitals, health services and system managers to identify and monitor HACs using existing data that is routinely generated from the patient medical record.

More information about the HACs groupers is available here.

Other supporting resources

The Commission and IHPA have developed other resources to support the implementation of the HACs. The first tool which has been developed is an animation which focuses on improving clinical documentation.

Watch our animation on the medical record and data-driven healthcare.

The Commission is also developing information for health care services and clinicians that will outline steps to avoid the occurrence of a HAC. This information will be available in the coming months.