Counting what counts for patient safety at SMHS

Two nurses at the bedside of a young boy.

South Metropolitan Health Service (SMHS) is committed to providing safe and high quality health care to all patients. As with every health system, however, despite the best intentions of our highly skilled and committed health professionals sometimes things don’t go to plan. Occasionally an unplanned event occurs that causes harm, or has the potential to cause harm – this is known as a clinical incident.

SMHS takes all clinical incidents seriously and to prevent recurrence, ensures systematic and in-depth investigation, analysis and implementation of learnings from these events. The clinical incident management process is undertaken in accordance with the WA Clinical Incident Management Policy and the WA Open Disclosure Policy Statement – noting that WA Health’s policy is to support and adopt the Australian Open Disclosure Framework.

A Severity Assessment Code (SAC) rating is applied to clinical incidents as an indicator of the actual or potential harm caused, as per the table below:

Table 1: Severity Assessment Code (SAC) rating definitions
Severity Assessment Code Definition 
SAC1 Clinical incidents/near misses where serious harm or death is/could be specifically caused by health care rather than the patient’s underlying condition or illness.
SAC2 Clinical incidents/near misses where moderate harm is/could be specifically caused by health care rather than the patient’s underlying condition or illness.
SAC3 Clinical incidents/near misses where minimal or no harm is/could be specifically caused by health care rather than the patient’s underlying condition or illness.

See how we measure up

The graphs below show the numbers of confirmed clinical incidents across SMHS sites and services, their Severity Assessment Codes (SACs) and activity using Occupied Bed-days (OBDs).

Bar charts and other graphs are used to display data. When comparing data it is important to exercise caution, as hospital activity varies between sites.

Figure 1: SMHS clinical incident rate per 1,000 occupied bed days (OBDs) by financial year (including trend line), 2014/15–2017/18

Graph demonstrates an increased rate of clinical incidents for SMHS from 2014/15 to 2015/16, and this increase coincided with an increase in activity (OBDs) across SMHS by 25 per cent for the same time period.

Figure 2: SMHS clinical incident rate per 1,000 occupied bed days (OBDs) by confirmed Severity Assessment Code (SAC) by financial year 2014/15–2017/18

Graph breaks down the confirmed clinical incidents by SAC over time and clearly illustrates the majority of clinical incidents continue to result in no or minor harm to the patient, and are confirmed as SAC3s.

What do these figures show?
  • Figure 1 demonstrates an increased rate of clinical incidents for SMHS from 20.36 per 1,000 OBDs in 2014/15, to 23.82 clinical incidents per 1,000 OBDs in 2015/16. This increase coincided with an increase in activity (OBDs) across SMHS by 25 per cent for the same time period. Between 2015/16 and 2017/18 SMHS maintained an average clinical incident rate of 21.7 clinical incidents per 1,000 OBDs across SMHS.
  • Figure 2 breaks down these confirmed clinical incidents by Severity Assessment Code (SAC) over time and clearly illustrates the following:
    • The majority of clinical incidents (89 per cent) continue to be confirmed as SAC3s at an average rate of 19.27 clinical incidents per 1,000 OBDs from 2014/15 to 2017/18 i.e. there was no or minor harm to the patient. A good level of clinical incident reporting with a low patient harm outcome usually demonstrates that a strong patient safety culture exists within the health service.
    • The rate of SAC1s reduced from 0.41 per 1,000 OBDs in 2014/15 to 0.23 per 1,000 OBDs in 2016/17, a reduction such as this is indicative of improvements in patient care.
Produced by

South Metropolitan Health Service