Learning From Complaints to the Health and Disability Commission Office: A Case Study Into Indicators of Deterioration in Aged Residential Care Organisations in New Zealand

Mowat, R
Dewer, J
Ram, F
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Journal Article
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Objective To identify trends in complaints received by the Health and Disability Commissioner (HDC) about aged residential care (ARC) facilities in order to learn from and implement positive changes in care.

Methods A case study of 24 deidentified publicly available HDC cases across three large New Zealand ARC organisations was completed. Cross-case analysis first involved analysis of each case individually and then compared all cases using inductive thematic analysis with the intention of drawing a single set of conclusions.

Results The speed at which the events occurred was contributory to the complaint, with 58% of the cases being rapid in nature and with sepsis being the predominant contributing factor to rapid decline and death. Six main diagnoses were indicators of deterioration: nutrition/hydration was indicated in 22% of the cases, followed by sepsis 17%, wounds 17%, UTI/renal issues 15%, falls 15% and respiratory issues 15%.

Conclusions Trends in Health and Disability complaints across multiple organisations can become a powerful tool for widespread quality improvement. This review highlights that the speed of deterioration triggered many complaints, especially in cases of sepsis which is possibly overlooked as a contributing problem. Also, that nutrition/hydration was indicated in many complaints and is an important condition-indicator. Trends in complaints are not generalisable to all large organisations; however, they can be applied to individual facilities.

Clinical deterioration; Errors; Long term care; Mapping; Quality improvement
Australasian Journal on Ageing. 2022;00:1-9. doi: 10.1111/ajag.13141
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© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.