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Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study
  1. Benjamin Michael Nowotny1,2,3,
  2. Miranda Davies-Tuck2,3,
  3. Belinda Scott4,
  4. Michael Stewart5,
  5. Elizabeth Cox6,
  6. Karen Cusack7,
  7. Martin Fletcher8,
  8. Eva Saar8,
  9. Tanya Farrell3,9,
  10. Shirin Anil3,
  11. Louise McKinlay3,
  12. Euan M Wallace1,3
  1. 1Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
  2. 2The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
  3. 3Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
  4. 4Executive Office, Djerriwarrh Health Services, Bacchus Marsh, Victoria, Australia
  5. 5PIPER, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  6. 6Obstetrics and Gynaecology, Monash Health, Clayton, Victoria, Australia
  7. 7Executive Office, Victorian Health Complaints Commission, Melbourne, Victoria, Australia
  8. 8Executive Office, Australian Health Practitioner Regulation Agency, Melbourne, Victoria, Australia
  9. 9Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Department of Health and Human Services, Melbourne, Victoria, Australia
  1. Correspondence to Professor Euan M Wallace, Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia; euan.wallace{at}


Objectives To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service.

Design Observational quantitative descriptive study.

Setting A public hospital maternity service in Victoria, Australia.

Data sources A public health service; the Victorian state health quality and safety office—Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency.

Main outcome measures Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients.

Results Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r2=0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality.

Conclusion While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.

  • patient safety
  • governance
  • healthcare quality improvement
  • incident reporting
  • obstetrics and gynecology
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  • Twitter @BenNowotny, @euan_wallace

  • Contributors BMN and EMW contributed to the conception, data collection, analysis and writing of the manuscript. MD-T, BS, MS, EC, KC, MF, ES, TF, SA and LM all contributed to the collection of data and writing of the manuscript.

  • Funding EMW is funded by a National Health and Medical Research Council (Australia) Program Grant.

  • Competing interests None declared.

  • Patient and public involvement statement No patient or public involvement was sought for this project.

  • Patient consent for publication Not required.

  • Ethics approval Human research ethics approval for the study was granted by Monash University Human Research Ethics Committee (HREC EC00382, project 8016). The Royal Children’s Hospital Melbourne Human Research Ethics Committee gave permission for the use of neonatal and perinatal transfer data (HREC EC00238, project 37054A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Due to the confidentiality requirements of data source agencies and human research ethics approval we will be unable to share source data. There is no discrete patient group to whom the findings can be disseminated.

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