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SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals): a protocol for a population-wide cohort study of outcomes of hospital care
  1. Isuru Ranasinghe1,2,3,
  2. Sadia Hossain3,
  3. Anna Ali3,
  4. Dennis Horton3,
  5. Robert JT Adams3,4,
  6. Bernadette Aliprandi-Costa5,
  7. Christina Bertilone6,
  8. Gustavo Carneiro7,
  9. Martin Gallagher8,9,
  10. Steven Guthridge10,
  11. Billingsley Kaambwa11,
  12. Sradha Kotwal8,12,
  13. Gerry O'Callaghan3,13,
  14. Ian A Scott2,14,
  15. Renuka Visvanathan3,15,16,
  16. Richard J Woodman17
  1. 1Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
  2. 2School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
  3. 3Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  4. 4College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  5. 5Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
  6. 6Healthcare Quality Intelligence Unit, Patient Safety and Clinical Quality Directorate, Clinical Excellence Division, Department of Health Government of Western Australia, Perth, Western Australia, Australia
  7. 7Faculty of Engineering Computer and Mathematical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  8. 8George Institute for Global Health, Sydney, New South Wales, Australia
  9. 9Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  10. 10Menzies School of Health Research, Casuarina, Northern Territory, Australia
  11. 11Health Economics Unit, Flinders University, Adelaide, South Australia, Australia
  12. 12The Prince of Wales Hospital, Sydney, New South Wales, Australia
  13. 13Intensive Care Services, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  14. 14Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  15. 15Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, The University of Adelaide, Adelaide, South Australia, Australia
  16. 16Aged & Extended Care Services, The Basil Hetzel Institute, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
  17. 17Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
  1. Correspondence to Associate Professor Isuru Ranasinghe; i.ranasinghe{at}


Introduction Despite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes.

Methods and analysis SAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories’ Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region’s Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals’ case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030.

Ethics and dissemination Human Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.

  • health & safety
  • quality in health care
  • public health

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  • Contributors IR conceived the study, developed the study design and drafted the manuscript. IR, SH, AA and DH assisted in the study design, data acquisition and drafting of the manuscript. RA, GC, MG, SG, IS, and RV contributed to the study design. RA, BA, CB, GC, MG, SG, BK, SK, GO, IS, RV and RW contributed to critical revision of the manuscript. All authors approved the final version to be published. All authors agree to be accountable for all aspects of the work.

  • Funding The Hospital Research Foundation.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either expressed or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

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

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