Hospital-acquired respiratory complications costly

Despite the strength of the Australian health system, an unacceptable number of Australian hospital admissions are associated with one or more hospital-acquired complications (HACs). These complications can adversely impact a patient’s recovery and overall outcome, as well as the length of their hospital admission.

Respiratory complications are one example of these HACs, affecting more than 10,600 patients in Australian hospitals each year. Patients with respiratory failure and acute respiratory distress syndrome experience profoundly distressing symptoms. These symptoms include shortness of breath to the point of air hunger and overwhelming anxiety, while patients with aspiration pneumonia may experience worsening shortness of breath, cough, purulent phlegm, fevers, sweats, fatigue and drowsiness.

Risk factors for respiratory failure include:

• chronic obstructive pulmonary disease
• impaired mobility and inability to elevate head
• recent surgery, abdominal and chest wounds
• obesity
• nutritional status and hydration
• impaired swallow and/or cough reflex
• recent chest infection with ongoing production of secretions
• respiratory centre depressants, such as opioids, benzodiazepines and post-anaesthetic drugs
• respiratory muscle weakness due to neuromuscular conditions
• respiratory muscle fatigue
• severely compromised states of health.

Increasing costs

In addition to causing the patient distress, respiratory complications are also costly. Patients with a hospital-acquired respiratory complication will, on average, remain in hospital for 17.9 days longer than patients without one. It is estimated that each episode of care with this HAC could cost the hospital an additional $37,125.

Fortunately, significant reductions in respiratory complication rates are being achieved in some hospitals through preventative initiatives that are focused on increasing the provision of patient care that mitigates avoidable risks.

In 2015–16, the rate of hospital-acquired respiratory complications across all Australians hospitals was 24 per 10,000 hospitalisations. However, if all principal referral hospitals reduced their rate to 30 per 10,000 hospitalisations, more than 1500 hospital-acquired respiratory complications would be prevented each year.

The Australian Commission on Safety and Quality in Health Care fact sheet on reducing hospital-acquired respiratory complications recommends a number of actions aligned with the National Safety and Quality Health Service (NSQHS) Standards (second edition), in particular the Comprehensive Care Standard, to reduce the number of these complications.

Some methods for preventing respiratory failure include:

• repositioning and/or mobilising the patient routinely
• elevating the bed head to sitting position
• providing supplementary oxygen as per medical orders
• active humidification for medical gases and appropriate administration of fluids according to the patient’s clinical history and situation
• active and passive chest physiotherapy
• managing pain effectively.

Putting systems in place

The recommendations contained in the Commission’s fact sheet are aligned with criteria set out in the Comprehensive Care Standard. Comprehensive care is the coordinated delivery of the total health care required or requested by a patient. This standard aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. For health service organisations with patients at risk of respiratory complications, these actions also include putting systems in place that are consistent with best-practice guidelines for the prevention of respiratory complications and ventilatory failure management.

Additionally, clinicians caring for patients at risk of respiratory complications should conduct comprehensive assessments and provide aspiration prevention and care in accordance with best-practice guidelines.

Further advice

All hospitals should be working towards reducing their rates of HACs. The Commission has released an information kit including fact sheets for reducing the occurrence of 16 of the most problematic HACs.

The fact sheets provide vital information for frontline clinicians, safety and quality professionals, managers, executives and members of governing bodies to minimise the occurrence of these complications: www.safetyandquality.gov.au/our-work/indicators/hospital-acquired-complications/hacs-information-kit/.

*Dr Robert Herkes is the Chief Medical Officer at the Australian Commission on Safety and Quality in Health Care, providing expert clinical advice to the wide range of programs managed by the Commission. 

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