Jesia Gail Berry

Attitudes and barriers to incident reporting: a collaborative hospital study

Objectives: To assess awareness and use of the current incident reporting system and to identify factors inhibiting reporting of incidents in hospitals. Design, setting and participants: Anonymous survey of 186 doctors and 587 nurses from diverse clinical settings in six South Australian hospitals (response rate = 70.7% and 73.6%, respectively). Main outcome measures: Knowledge and use of the current reporting system; barriers to incident reporting. Results: Most doctors and nurses (98.3%) were aware that their hospital had an incident reporting system. Nurses were more likely than doctors to know how to access a report (88.3% v 43.0%; relative risk (RR) 2.05, 95% CI 1.61 to 2.63), to have ever completed a report (89.2% v 64.4%; RR 1.38, 95% CI 1.19 to 1.61), and to know what to do with the completed report (81.9% v 49.7%; RR 1.65, 95% CI 1.27 to 2.13). Staff were more likely to report incidents which are habitually reported, often witnessed, and usually associated with immediate outcomes such as patient falls and medication errors requiring corrective treatment. Near misses and incidents which occur over time such as pressure ulcers and DVT due to inadequate prophylaxis were least likely to be reported. The most frequently stated barrier to reporting for doctors and nurses was lack of feedback (57.7% and 61.8% agreeing, respectively). Conclusions: Both doctors and nurses believe they should report most incidents, but nurses do so more frequently than doctors. To improve incident reporting, especially among doctors, clarification is needed of which incidents should be reported, the process needs to be simplified, and feedback given to reporters.

Consumer perceptions of safety in hospitals

BackgroundStudies investigating adverse events have traditionally been principally undertaken from a medical perspective. The impact that experience of an adverse event has on consumer confidence in health care is largely unknown. The objectives of the study were to seek public opinion on 1) the rate and severity of adverse events experienced in hospitals; and 2) the perception of safety in hospitals, so that predictors of lack of safety could be identified.MethodsA multistage, clustered survey of persons residing in South Australia (2001), using household interviews (weighted n = 2,884).ResultsA total of 67% of respondents aged over forty years reported having at least one member of their household hospitalised in the past five years; with the average being two hospital admissions in five years. Respondents stated that 7.0% (95%CI: 6.2% to 7.9%) of those hospital admissions were associated with an adverse event; 59.7% of respondents (95% CI: 51.4% to 67.5%) rated the adverse event as really serious and 48.5% (95% CI: 40.4% to 56.8%) stated prolonged hospitalisation was required as a consequence of the adverse event. Perception of safety in hospitals was largely affected by the experience of an adverse event; really serious events were the most significant predictor of lack of safety in those aged 40 years and over (RR 2.38; p<0.001).ConclusionThe experience of adverse events negatively impacted on public confidence in hospitals. The consumer-reported adverse event rate in hospitals (7.0%) is similar to that identified using medical record review. Based on estimates from other studies, self-reported claims of adverse events in hospital by consumers appear credible, and should be considered when developing appropriate treatment regimes.

Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?

Objectives: To estimate trends in incidence rates of rugby code‐related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies.

A randomised controlled trial to compare opt-in and opt-out parental consent for childhood vaccine safety surveillance using data linkage: study protocol

BackgroundThe Vaccine Assessment using Linked Data (VALiD) trial compared opt-in and opt-out parental consent for a population-based childhood vaccine safety surveillance program using data linkage. A subsequent telephone interview of all households enrolled in the trial elicited parental intent regarding the return or non-return of reply forms for opt-in and opt-out consent. This paper describes the rationale for the trial and provides an overview of the design and methods.Methods/DesignSingle-centre, single-blind, randomised controlled trial (RCT) stratified by firstborn status. Mothers who gave birth at one tertiary South Australian hospital were randomised at six weeks post-partum to receive an opt-in or opt-out reply form, along with information explaining data linkage. The primary outcome at 10 weeks post-partum was parental participation in each arm, as indicated by the respective return or non-return of a reply form (or via telephone or email response). A subsequent telephone interview at 10 weeks post-partum elicited parental intent regarding the return or non-return of the reply form, and attitudes and knowledge about data linkage, vaccine safety, consent preferences and vaccination practices. Enrolment began in July 2009 and 1,129 households were recruited in a three-month period. Analysis has not yet been undertaken. The participation rate and selection bias for each method of consent will be compared when the data are analysed.DiscussionThe VALiD RCT represents the first trial of opt-in versus opt-out consent for a data linkage study that assesses consent preferences and intent compared with actual opting in or opting out behaviour, and socioeconomic factors. The limitations to generalisability are discussed.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000332022

Randomized controlled trial of alendronate in airways disease and low bone mineral density

Background:Patients with airways disease have been demonstrated to be at risk of osteoporosis, and this is likely to be multifactorial. Our aim was to identify patients with low bone mineral density (BMD) using a screening program, and then evaluate the benefit of daily alendronate. Method:Subjects with hip or lumbar spine baseline T-scores <-2.5, or Z-score <-1.0 commenced on alendronate/calcium (10 mg/600 mg day) or placebo/calcium, in a double blind randomized controlled trial. BMD by dual emission X-ray absorptiometry (lumbar vertebrae 2-4, neck of femur, total femur) was repeated after 12 months, with adverse events recorded. Results: 145 subjects (74 male, 71 female, mean age 67, median FEV, 1.0 litres = 43% of predicted) were enrolled; 66 alendronate/calcium, 79 placebo/calcium with 24 and 26 withdrawals, respectively. Per protocol but not intention to treat analysis of covariance demonstrated statistically significant improvements in T and Z scores for lumbar spine bone mineral density (P = 0.035, P = 0.040), with no improvement demonstrated at the hip. Conclusions:Improvement in bone mineral density has been demonstrated at the lumbar spine, but not hip, by per protocol analysis, with daily alendronate, at 12 months.

Head and traumatic brain injuries among Australian children, July 2000–June 2006

Objective To describe the rates of hospitalisation for head and traumatic brain injury among Australian children aged 0–14 years. Design Descriptive analysis of the Australian Institute of Health and Welfare National Hospital Morbidity Database, using data for the period 1 July 2000 to 30 June 2006. Results The rate of hospitalisation for head injury was 395.9 per 100 000 (95% CI 393.4 to 398.4), with 47.6 per 100 000 (95% CI 46.7 to 48.5) being high-threat-to-life injuries. In multivariate analysis, those aged 0–4 years had 1.8 times the rate of head injury of 10–14-year-olds, while boys had 1.7 times the rate of girls. Children living in very remote and remote areas had a 1.3–1.5-fold greater rate of head injury, and a 1.6–1.8-fold greater rate of injuries that were high threat to life, than city-dwelling children. The rate of traumatic brain injury (TBI) was 91.1 per 100 000 (95% CI 89.9 to 92.3), with 34.7 per 100 000 (95% CI 33.9 to 35.4) being high-threat-to-life injuries. In multivariate analysis, children aged 0–4 years had 0.8 times the rate of 10–14-year-olds, and boys had 1.9 times the rate of girls. Children living in the very remote and remote areas had a 1.9–2.8-fold greater rate of TBI, and a 1.5–1.7-fold greater rate of injuries that were high threat to life, than city-dwelling children. Conclusions Children living remotely were disproportionately represented among those sustaining head injuries. Almost a quarter of head injuries were TBI.

Hospital admissions of indigenous and non-indigenous Australians due to interpersonal violence, July 1999 to June 2004

Objective: To compare the incidence of injury‐related hospitalisations and the injury profiles for interpersonal violence, in the Indigenous and non‐Indigenous populations of Australia.

Head and traumatic brain injuries among Australian youth and young adults, July 2000-June 2006

Objectives: To describe rates of hospitalization for head and traumatic brain injury (TBI) among Australian adults aged 15–24 years. Design: Descriptive analysis of the Australian Institute of Health and Welfare National Hospital Morbidity Database, using data from 1 July 2000 to 30 June 2006. Results: The rate of hospitalization for head injury was 618.5 per 100 000, with 148.1 per 100 000 being high threat to life injuries. In multivariate analysis, males had 3.2-times the rate of females. Youth and young adults living in remote and very remote areas had a 2.6–3.2-fold greater rate of head injury than city-dwellers and a 2.3–2.7-fold greater rate of injuries that were high threat to life. The rate of TBI was 169.3 per 100 000, with 87.1 per 100 000 being high threat to life injuries. In multivariate analysis, males had 3.2-times the rate of females. Youth and young adults living in very remote and remote areas had a 2.5–3.0-fold greater rate of TBI than city-dwellers and a 2.1–2.3-fold greater rate of high threat to life TBI. Conclusions: Males and youth and young adults living remotely were disproportionately represented among those sustaining head injuries. A quarter of hospitalized head injuries were coded as having TBI.

Parent perspectives on consent for the linkage of data to evaluate vaccine safety: A randomised trial of opt-in and opt-out consent

Background We examined parents’ consent preferences and understanding of an opt-in or opt-out invitation to participate in data linkage for post-marketing safety surveillance of childhood vaccines. Methods A single-blind parallel-group randomised controlled trial: 1129 families of babies born at a South Australian hospital in 2009 were sent information at 6 weeks post-partum, explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance, with 4 weeks to opt in or opt out by reply form, telephone, or email. At 10 weeks post-partum, 1026 (91%) parents were followed up by telephone interview. Results In both the opt-in (n = 564) and opt-out arms (n = 565), four-fifths of the parents recalled receiving the information (81% vs. 83%, P = 0.35), three-fifths reported reading it (63% vs. 67%, P = 0.11), but only two-fifths correctly identified the health records to be linked (43% vs. 39%, P = 0.21). Parents who actively consented (opted in) were more likely than those who passively consented (did not opt out) to recall the information (100% vs. 83%, P < 0.001), report reading it (94% vs. 67%, P < 0.001), and correctly identify the data sources (60% vs. 39%, P < 0.001). Most parents supported data linkage for vaccine safety surveillance (94%) and trusted its privacy protections (84%). Most parents wished to have minimal or no direct involvement, preferring either opt-out consent (40%) or no consent (30%). A quarter (24%) of parents indicated opt-in consent should be sought; of these, 8% requested consent prior to every use, 5% preferred to give broad consent just once and 11% preferred periodic renewal. Three-fifths of the parents gave higher priority to rapid vaccine safety surveillance (61%) rather than first seeking parental consent (21%), and one in seven was undecided (15%). Although 91% of parents reported that their babies were fully immunised (76%) or under-immunised (15%), and trusted vaccines as safe (90%), three-fifths (62%) were very or somewhat concerned about serious reactions. Limitations The context of data linkage is limited to vaccine safety surveillance. Only recall and understanding retained at 1 month post enrolment were measured. Conclusions This trial demonstrates that informed consent for a population-based surveillance programme cannot realistically be achieved using mail-based opt-in and opt-out approaches. While recall and understanding of the study’s purpose were better among parents who actively consented (opted in) compared with parents who passively consented (did not opt out), participation was substantially lower (21% vs. 96% respectively). Most parents appeared to have a poor understanding of data linkage for vaccine safety surveillance; nonetheless, they supported data linkage. They preferred a system utilising opt-out consent or no consent to one using opt-in consent.

Identification of Aboriginal children using linked administrative data: consequences for measuring inequalities

The aim of this study was to examine the identification of Aboriginal children in multiple administrative datasets and how this may affect estimates of health and development.