Almost 1100 cases of major harm and 34,000 cases of minor harm occurred in "clinical incidents" at Hunter hospitals in six years, health data shows.
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There were 47 cases of an unexpected death or "sentinel event" [preventable incident causing death or serious harm] at John Hunter Hospital from 2018 to 2023.
The Newcastle Herald obtained the data through the Government Information Public Access (GIPA) Act.
The major harm incidents at hospitals were: John Hunter (455), John Hunter Children's (47), Calvary Mater (123), Belmont (99), Maitland (220), Cessnock (38), Kurri Kurri (31), Singleton (47), Muswellbrook (23) and Dungog (less than 20).
Hunter New England Health did not provide the precise number of cases of an unexpected death or sentinel event at hospitals, except for John Hunter.
It would only say this figure was "less than 20" at each of the other hospitals over the six-year period.
However, the data showed 97 "root cause analysis/serious adverse event reviews" occurred at all the Hunter hospitals over the six-year period.
A root cause analysis of a serious adverse event occurs to pinpoint issues in the system that contributed to serious patient harm.
The data also showed 16,704 cases of minor harm and 20,868 cases of "no harm or near miss" at John Hunter from 2018 to 2023.
At the other hospitals, these figures were John Hunter Children's (1026 and 3256), Calvary Mater (6353 and 6995), Belmont (2449 and 3322), Maitland (4076 and 7902), Cessnock (863 and 983), Kurri (1272 and 1195), Singleton (677 and 1167), Muswellbrook (483 and 1068) and Dungog (77 and 174).
A Hunter New England Health spokesperson said "more than 650,000 people receive high-quality care in our district's hospitals every year".
The spokesperson added that the hospitals' healthcare standards were "among the safest in the world".
"The overwhelming majority of patients cared for in our hospitals have a positive outcome."
Staff are required to report "all clinical incidents, near misses and complaints".
Feedback on lessons learned [with names confidential] and proposed changes were shared with clinicians, managers and staff across the district.
"We offer support to staff involved in clinical incidents, including through our Employee Assistance Program which provides confidential, professional and free counselling services," the spokesperson said.
NSW Nurses and Midwives' Association general secretary Shaye Candish said there "needs to be an overhaul of the current Employee Assistance Program to better support staff following traumatic incidents".
"Nurses and midwives are only provided with up to 10 counselling sessions a year, compared to other industries which provide unlimited sessions," she said.
She said communication with nurses and midwives was "often poor after incident reports are made, leaving staff feeling deflated in the process".
"Welfare checks and debriefing should be offered to nurses and midwives in a constructive and empathetic manner, but unfortunately it doesn't happen as frequently as it should."
She added that staff need "more proactive support before incidents occur", including adoption of "prevention measures".
Ms Candish said "role overload" was a "significant work health and safety issue impacting our members".
She said this issue was "created by statewide nursing and midwifery shortages, coupled with insufficient staffing".
"We know that patients receive better quality care when nurses and midwives have a more manageable patient load," she said.
Professor Peter Hibbert, of the Australian Institute of Health Innovation at Macquarie University, said reporting of clinical incidents had been rising since they began 20 years ago.
"As people get used to the system, they feel more comfortable and realise the sky won't fall in when they report," Professor Hibbert said.
"The response of the health service is just as important as the report itself."
He said efforts had been made to create "a fair and just culture" around the reporting system.
"So when an adverse event occurs, the first thing to look at is the system in which people are working," he said.
"If there's a medication error, it may be that there wasn't a double check done.
"That may have been because a nurse was fatigued and they were doing multiple things at the same time."
Errors were sometimes caused by "misinterpretation of electronic medical records or medication management systems".
Australian Medical Association NSW president Dr Kathryn Austin said the state had a "robust system of reporting critical incidents".
"The reporting of incidents in and of itself is not an indication of poor quality care or practices," Dr Austin said.
"It is important for incidents to be reported and investigated."
Professor Hibbert said worldwide research showed that "about 10 per cent of hospital admissions are associated with some sort of adverse event".
"Most of those are minor," he said, adding that "you're dealing with ill people in a complex system".
He said patients and their families should "advocate for themselves".
"If you're worried about something, talk to a doctor or nurse."
