Regular review of, and action on, markers of quality of care is an integral part of quality improvement. It is important to build processes into clinical governance frameworks to allow routine collection, review and action on timely and targeted data.
To support this, the Australian Commission on Safety and Quality in Health Care has provided detailed specifications for a number of quality measures that facilities can use to review their processes and outcomes relating to recognising and responding to clinical deterioration. The Commission suggests these measures are the most useful for facilities to use to enable robust evaluation of recognition and response systems but they are not mandatory. A number of audit and evaluation tools have also been developed.
The frequency of data reviews or audits will vary according to the measure being used and the context of the health service. For example, measures such as unexpected cardiopulmonary arrest or failed escalation with mortality might be measured monthly or quarterly in a large hospital, but only annually in a smaller day surgery hospital where such events are rare. Audit frequency may also vary depending on the stage of implementation. For example, the documentation of core physiological observations might be audited weekly or monthly in the initial implementation phase, but only quarterly or biannually when systems are well embedded.
These quality measures have been put forward to support local evaluation and quality improvement. They are not designed for performance monitoring or benchmarking. The Commission does not require collection of information about these measures; however, they do align with the National Safety and Quality Health Service Standards, current and proposed processes for data collection where they exist at a state and territory level, and with the rapid response system indicators included in the Australian Council of Healthcare Standards Intensive Care Clinical Indicators Version 4 (PDF 1.8MB). The quality measures have been developed using an adapted version of the Australian Institute of Health and Welfare’s METeOR framework.