Online Hospital Complications Calculator launched

by Stephen Duckett


Published by the Sydney Morning Herald, Thursday 15 February

One in four patients who stay overnight in an Australian hospital will have something go wrong,  but a veil of secrecy hangs over which hospitals – and which doctors – have higher rates of complications and which are safety leaders.

The Grattan Institute has also found that a patient’s risk of developing a complication also varies dramatically depending on which hospital they go to. While researching our report All complications should count: Using data to make hospitals safer, we found that in some cases, the additional risk at the worst-performing hospitals can be four times higher than at the best performers.

Safety statistics are collected for both public and private hospitals but they are kept secret, not just from patients but also from doctors and hospitals, who should be able to access this information to see how they are performing compared to their peers – and to learn from those who do things best.

To make it easier for patients to know what to expect before they get to hospital – and what questions to ask their doctor – the Grattan Institute has developed an online calculator that enables patients and their families to discover how likely it is that complications will arise from a whole gamut of treatment.

Using detailed hospital statistics compiled over three years, as well as information about the patient, the calculator instantaneously determines the chances of them suffering a complication: anything from the dangerous to the merely inconvenient.

Imagine your mother is going into hospital next week for breast surgery. You’re worried because you know that, even in the best of hands and with the best of technology, things can go wrong. If you use the calculator and key in the reason for her hospital admission (breast surgery), her gender (female), her age (let’s say 50-64) and her length-of-expected-stay (several days rather than same-day), then the calculator tells you that she has a 12 per cent chance of a complication.

If she were having multi-day gynaecological treatment instead, her prospects of a complication would rise to 18 per cent. For multi-day heart surgery it’s 52 per cent, vascular surgery 29 per cent, and so on (the list also includes colorectal surgery, ear, nose and throat surgery, haematology, neurology surgery, obstetrics, orthopaedics, kidney treatment, and urology).

That’s not all. The calculator also gives you a list of the most common types of complications for each treatment.

So, it’s most likely that your mum would suffer a complication relating to haemorrhaging (which occurs in 3.2 per cent of breast surgery for women of your mother’s age). The next most likely complication for such women is low blood pressure (2.3 per cent). There’s a 2 per cent chance that your mum will suffer nausea and vomiting after her procedure.

But if we had access to hospital-by-hospital data on complication rates, the calculator could be expanded so that patients could find out not only their chances of suffering a complication, but how their chances would go up or down depending on whether they chose to go to their local public hospital, the private hospital in the next suburb, or the major teaching hospital in their nearest capital city. And it would help improve safety across all Australian hospitals.

Our report shows that if all hospitals lift their safety performance to the level of the best 10 per cent of Australian hospitals, an extra 250,000 patients could leave hospital each year free of complications.

One of them could be your mother.

So, here’s our challenge to the health ministers of Australia: release the hospital-by-hospital data on complication rates. All this information is held now in computers in Canberra and in each capital city. Making it available for you and your mother would cost almost nothing. But it would help you and her ask the right questions of her surgeon about what might happen and what it means. Simple but important questions like: is there anything Mum can do to reduce the risk of complications arising from her surgery?

Incorporating those sorts of specifics into the hospital complications calculator would enable patients – and their GPs – to make better-informed decisions about their treatment options.

And that sort of public exposure just might prompt some of our worst-performing hospitals to lift their game.