Is a wholistic quality improvement program to reduce hospital-acquired complications economically viable in an Australian local health service?

Abstract

ObjectiveThe aim of this study was to estimate avoidance of hospital bed-days and the resulting cost savings from a wholistic quality improvement program that was implemented to systematically reduce hospital-acquired complications (HACs) in an Australian local health service between 2018 and 2023.MethodsThis was an uncontrolled retrospective observational analysis of prospectively collected data. An association between HAC and length of stay (LOS) was explored through a zero truncated negative binomial regression model for two LOS cohorts, using 21days as the threshold for long-stay share of bed-days. Bed-day cost avoidance was estimated by applying the adjusted marginal effect of HAC on LOS, multiplied by the estimated number of HAC episodes averted, average weighted average units per bed-day, and the national efficiency price in respective years.ResultsHACs were found to increase hospital bed-days by an average of 5.5days (95% CI: 5.19-5.86) for episodes with LOS of 1-21days, and by 7.1days (95% CI: 6.78-7.48) for episodes with LOS exceeding 21days. The program resulted in an estimated avoidance of HACs in 2991 episodes of care over a 5-year period, averaging 598 episodes per year. This equated to avoidance of a total of 16,751 hospital bed-days, or 3350 annually. Annual cost voidance from bed-days ranged from A$6.4 to A$11.5million between 2019 and 2023. The budget for program management was A$514,500 per year, resulting in average net benefits of A$7.1 to A$8.2million, a 14-16-fold return on investment for the health service.ConclusionFindings suggest that financially viable opportunities are available for hospitals to achieve sustained reduction in HACs, which have the potential for wider adoption to tackle the challenges associated with adverse events in hospitals.