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Objective: To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation.Design: Longitudinal incidence study using routinely-collected electronic care management data.Setting: A large aged care service provider in New South Wales and the Australian Capital Territory, Australia.Participants: About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016.Main Outcome Measure: Risk-adjusted PI incidence rates over eight study quarters.Results: Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038).Conclusions: There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention. [ABSTRACT FROM AUTHOR]

Purpose Patient transportation is an important component of health-care delivery; however, the quality and safety issues relating to non-emergency patient transport services have rarely been discussed compared with the transport of emergency patients. This systematic review examines the factors associated with the quality and safety of non-emergency transport services. Data sources Medline, Pre-Medline, CINAHL and Embase databases were searched for publications between 1990 and September 2009. Study selection Articles investigating non-emergency hospital transport services. Data extraction Study characteristic and outcome data were abstracted by one author and reviewed by a second and third author. Results Twelve articles from seven countries were included. Five studies examined issues relating to the structure of transport services, which focused on the use of policies and protocols to assist the transfer process. All studies addressed factors associated with the transfer process such as communication, appropriateness of personnel, time to arrange transfers, and the safety and efficiency of the process. Outcomes were measured in one study. Conclusions Communication, efficiency and appropriateness are key factors that are advanced as impacting on the quality and safety of non-emergency transport services. Standardization of the non-emergency transport process shows promise in reducing risk and increasing efficiency. Applying information and communication technology to improve the quality of transport services has received little attention despite its potential benefits. Patient outcomes in relation to quality and safety of transport services are rarely measured. Available evidence suggests that safety of non-emergency patient transfers is sometimes compromised due to poor standardization and failures in communication processes. [ABSTRACT FROM AUTHOR]