Ramsay Surgical Centre Miranda
Part of Ramsay Health Care

Clinical Safety and Quality Indicators

When you receive treatment and services by Ramsay Health Care, you can expect a high level of professional expertise and safe and effective care. We want you to feel reassured and understand what you are experiencing during your stay in hospital as well.

We encourage you to ask questions about any aspect of your care, and participate in planning and decisions about your treatment.

Ramsay Health Care aims to improve safety for patients by minimising key risks and optimising the quality of the services we provide. In each of our hospitals, we focus on known risks to our patients which, for example may include: falls, medication safety and pressure injuries.

Open Disclosure

Every effort is made to minimise risk, unfortunately, incidents do occur and Ramsay Health Care supports open disclosure.  This is the process of open communication with patients and families when an incident results in unintended harm.  It involves discussion of the incident, investigation and any actions taken to improve the care delivered and ensure the incident is not repeated. Read more information.

Patient Identification/Information Sharing

Sharing of information about your care while you are in hospital is an important aspect of ensuring your safety and continuity of care between your doctor, nurse and other healthcare workers.  Every day, at the start of a shift, a handover is undertaken by staff. One aspect of the handover is at the bedside, which is an opportunity for you, your family or your carer to be involved - by asking questions, clarifying concerns and participating in your care including your discharge from hospital.

What you can do to reduce your risk

You will be given an identification band when you are admitted to hospital. Staff may refer to it as an 'ID band' or a 'wrist band'. It will include your name and date of birth, and be placed on your wrist or leg.

You should:

  • Always wear your ID band
  • Make sure the information on the ID band is correct
  • Check that you have a red ID band if you have any allergies

Staff will check your ID band before every test or procedure and before giving you any medication. They will also ask you what your name is and other details, to make sure that the right patient is getting the right treatment every time.

All our hospital staff should be wearing an identification badge. If you can't see their badge, or you're not sure who someone is, please ask

Hygiene and Infection indicators

We aim to minimise the risk of infection to patients, staff and visitors that come to our hospitals across Australia. Our infection rates have been consistently below the industry benchmark.

What Ramsay Health Care does to reduce your risk

Ramsay Health Care has a programs in place to detect and prevent infections that are common within health care hospitals. Visitors to Ramsay hospitals are encouraged through appropriate signage to use antiseptic hand rub located throughout our hospitals.

What you can do to reduce your risk

There are several ways you can assist in preventing an infection:

  • Always wash your hands after using the toilet, bedpan or a commode
  • Wash or clean your hands before eating
  • Don’t be afraid to ask your doctor or staff caring for you, if they have washed their hands
  • Avoid touching your wound or devices (for example fluid tubes into your arm or drain tubes)
  • Let the care staff know if your wound or areas around any of the lines or tubes become red or swollen or painful
  • Discourage visitors who may be feeling unwell
  • Stop smoking before any surgery, as smoking increases the risk of infection

One of the most effective ways to prevent infection spreading amongst patients is for all health professionals to wash their hands. Hand hygiene is conducted in accordance with the ‘five moments’ that is; before touching a patient; before a procedure; after a procedure; after touching a patient; and after touching a patient’s environment.
Ramsay Health Care participates in the national hand hygiene strategy through Hand Hygiene Australia, and Hand hygiene audits are conducted three times per year.

Hand hygiene compliance is reported as the percentage of correct moments from all observed moments.

Hand Hygiene compliance (A higher rate is better)

Unplanned return to theatre (A lower rate is better)


Medicines are commonly used to treat a variety of conditions in the healthcare setting, and therefore, it is important to measure the risk of errors. Ramsay Health Care has a very low rate of medication errors due to its implementation of a range of medication safety strategies.

What Ramsay Health Care does to reduce your risk

Ramsay Health Care takes all medication errors very seriously. We encourage staff to report all medication errors as incidents, no matter how minor they may seem. All medication incidents are investigated and actioned and any serious medication incidents are investigated thoroughly and monitored by Ramsay’s National Clinical Governance Unit.
In addition, Ramsay Health Care has medication administration policies and processes in place which have been developed using best practice principles.
The Australian Commission on Safety and Quality in Health Care has introduced safety initiatives for medication administration and reconciliation and Ramsay Health Care has adopted these strategies. This includes the National Inpatient Medication Chart which standardises the documentation on how medicines are prescribed and ordered. Adoption by Ramsay Health Care of the User-Applied Labelling of Injectable Medicines recommendations has assisted in preventing medication errors related to the wrong route, dose or medication being administered.

What you can do to reduce your risk

We encourage you to be involved in the management of your medicines, if you have any concerns please discuss this with your doctor, pharmacist or nurse.

It is important during your stay with us that we know what medicines you are taking. Our doctors, pharmacists and nurses will ask you about the medications you take at home, including any complementary or alternative therapy medicines, for example vitamins, nutritional supplements, homeopathic medicines, Chinese or Ayurvedic medicines and Australian indigenous medicines. 

It is important you advise the staff of any allergies you have experienced or any reactions you have had to medicines taken in the past.

The serious medication error indicator is reported as a percentage of all patient days during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for this indicator. It is calculated by dividing the number of patients who require medical intervention as a result of a medication safety incident by number of days for all patients who were admitted.

Serious medication errors (A lower rate is better)

Comprehensive care indicators


The risk of falling increases according to age; with data suggesting that one third of people over the age of 65 years have one or more falls a year. Falls can occur at all ages, though the frequency and severity of fall-related injuries increases significantly with age. These injuries can include minor skin abrasions, joint dislocation, fractures and head injuries. These injuries may result in hospitalisation or an increased length of stay in hospital.

The risk of falling can greatly increase when admitted to hospital due to a range of factors including: illness and unsteadiness, adapting to a new environment, the introduction of new medications and walking in unsafe footwear or slippers.

What Ramsay Health Care does to reduce your risk

In 2015, Ramsay Health Care increased the focus on falls prevention in hospitals by appointing a National Falls Prevention Advisory Group. This group has standardised the approach to falls prevention across all Ramsay hospitals by targeting a structured risk assessment, policy and guidelines, equipment for falls prevention and clinical staff education.
Our hospitals use a number of strategies to prevent falls and these include: targeted hourly rounding of patients identified as high risk of falling; ensuring that call bells and personal items are within patient reach; call bells are answered promptly, and patients are assisted to the toilet at regular intervals. In addition, Ramsay Health Care has purchased low beds, falls mats, and patient alarms to minimise the risk of patients falling whilst in our hospitals.

What you can do to reduce your risk

Falls can be a major cause of injury.  We want to protect you from a fall during your hospital stay and you can help by:

  • Becoming familiar with your surroundings
  • Get to know how the bed controls work and how to use the call bell – if you cannot reach it, ask your nurse to move it within your reach
  • If you need help, use the call bell to alert staff
  • Wear supportive, flat, non-slip shoes – do not walk around in socks or pressure stockings (TED stockings)
  • If you use glasses, hearing aids, a walking stick or walker, keep them in easy reach by the bedside, use the call bell to ask staff to assist you
  • Make sure your bed height is appropriate for you to get in and out of – if your bed is too high ask the nurse to adjust it for you
Falls indicators are reported as a percentage of all patient days during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for these indicators. The indicators are calculated by dividing the number of inpatient falls that meet the indicator criteria by number of days for all patients who were admitted.

Patient Falls (Lower score is better)