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The Northern Centre for Healthcare Improvement (Click Here to go to the NCHI Website)

What is NCHI?

The Northern Centre for Healthcare Improvement (NCHI) is part of Northern Sydney Central Coast Health (NSCCH).  NCHI is a public sector not-for-profit organisation, which operates throughout Australia and internationally.

There are four programs within the Centre:

• Education & Training (including the Clinical Practice Improvement Program)

• Projects

• Audit and review (including QaRNS)

• Research

Key components of our operations are education and training in quality improvement, project and collaborative management, the epidemiology and investigation of adverse events, and consultancy services in the area of patient safety.   The expertise available to NCHI is well recognised at international and national levels.  We strive to identify and collaborate with individuals and organisations who share our values. 

The QaRNS Program

Patient safety is a major priority in healthcare organisations.  The risk of illness or injury being caused by medical treatment or care is particularly high in the acute hospital environment.  In order to maintain a high standard of patient care, it is vital that adverse events and unexpected patient outcomes are identified and evaluated, and the system of healthcare is continuously improved as a result.123

QaRNS is an area-wide patient focused quality improvement program within Northern Sydney Central Coast Health (NSCCH), based at Royal North Shore Hospital, Sydney.  QaRNS has been in operation since 1991 and has received international recognition from the International Society for Quality Assurance in Health Care (ISQua).

The program reviews a flagged subset of medical records, which may have a higher adverse event rate than the rest of the patient population.  The program uses a two stage review methodology:

1. The first stage review is undertaken by specially trained and highly experienced nurses, Quality Care Reviewers, who review the flagged population of patient records against a number of general screening criteria.  The purpose of this review is to identify breaches in standards of patient care or adverse events. 

2. The second stage review, where a problem has been identified, is undertaken by a senior clinician from the relevant clinical department who assesses preventability of the event. 

Preventable adverse events will trigger a multi-disciplinary peer review meeting within the relevant department.  These cases are then presented to the Clinical Review Committee (CRC) for evaluation and recommendations, where appropriate.

All cases reviewed are entered into a database in order to produce both sentinel case reports and aggregated trend data. Each year between 7-12% of total inpatients are flagged for review by the QaRNS program.