Hospital-acquired complications (HACs)

A hospital-acquired complication (HAC) refers to a complication for which clinical risk mitigation strategies may reduce (but not necessarily eliminate) the risk of that complication occurring. 

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Hospital-acquired complications list

The national list of 16 HACs was developed through a comprehensive process that included:

  • Reviews of the literature
  • Clinical engagement
  • Testing of the concept with public and private hospitals.

For more information about this process, see Development of this HACs list.

The HACs list offers 16 agreed, high-priority complications which clinicians, managers and others can work together to address and improve patient care.

Complication Diagnosis
Pressure injury
  • Stage III ulcer
  • Stage IV ulcer
  • Unspecified decubitus ulcer and pressure area
  • Unstageable pressure injury
  • Suspected deep tissue injury
Falls resulting in fracture or intracranial injury
  • Intracranial injury
  • Fractured neck of femur
  • Other fractures
Healthcare-associated infection
  • Urinary tract infection
  • Surgical site infection
  • Pneumonia
  • Blood stream infection
  • Infections or inflammatory complications associated with peripheral/central venous catheters
  • Multi-resistant organism
  • Infection associated with prosthetics/implantable devices
  • Gastrointestinal infections
  • Other high impact infections
Surgical complications requiring unplanned return to theatre
  • Post-operative haemorrhage/haematoma requiring transfusion and/or return to theatre
  • Surgical wound dehiscence
  • Anastomotic leak
  • Vascular graft failure
  • Other surgical complications requiring unplanned return to theatre
Unplanned intensive care unit admission
  • Unplanned admission to intensive care unit
Respiratory complications
  • Respiratory failure including acute respiratory distress syndrome requiring ventilation
  • Aspiration pneumonia
  • Pulmonary oedema
Venous thromboembolism
  • Pulmonary embolism
  • Deep vein thrombosis
Renal failure
  • Renal failure requiring haemodialysis or continuous veno-venous haemodialysis
Gastrointestinal bleeding
  • Gastrointestinal bleeding
Medication complications
  • Drug related respiratory complications/depression
  • Haemorrhagic disorder due to circulating anticoagulants
  • Movement disorders due to psychotropic medication
  • Serious alteration to conscious state due to psychotropic medication
Delirium
  • Delirium
Incontinence
  • Urinary incontinence
  • Faecal incontinence
Endocrine complications
  • Malnutrition
  • Hypoglycaemia
Cardiac complications
  • Heart failure and pulmonary oedema
  • Arrhythmias
  • Cardiac arrest
  • Acute coronary syndrome including unstable angina, STEMI and NSTEMI
  •  Infective endocarditis
Third and fourth degree perineal laceration during delivery
  • Third and fourth degree perineal laceration during delivery
Neonatal birth trauma
  • Neonatal birth trauma
  • Hypoxic ischaemic encephalopathy

Hospital-acquired complications resources

The Commission has developed a range of resources to support adoption of the HACs list and improve patient safety and healthcare quality. These include:

These resources:

  • Support health services to monitor HACs
  • Put in place strategies to either reduce high rates of HACs, or maintain low HACs rates.

These resources, and the focus of the HACs, recognise that HACs affect patients, their families and the healthcare system.

Review

The HACs list and specifications are reviewed regularly. To provide feedback on the HACs list, please email indicators@safetyandquality.gov.au. Feedback will be considered by the HACs Curation Clinical Advisory Group as part of future reviews.

Version 3.1 of the HAC list was released in March 2021, with the update to ICD-10-AM 12th edition in April 2022. Version 3.1 will be used by the Independent Hospital Pricing Authority from 1 July 2022.

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