YOUR MORTALITY RATE IS YOUR PULSE
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- Johnathan Gregory
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1 4 YOUR MORTALITY RATE IS YOUR PULSE (KEEP YOUR FINGER ON IT) MEASURING MORTALITY IN THE NHS
2 MEASURING DEATHS IS A GOOD WAY OF CHECKING HOW WELL HOSPITALS ARE CARING FOR PATIENTS FIND MORE INFORMATION ABOUT MORTALITY RATES AT 2012/13 IN NUMBERS 237,100 PATIENTS DIED IN HOSPITAL IN 2012/13 4,400 MORE THAN 2011/12 5,300 FEWER THAN 2010/11 THE SECOND LOWEST NUMBER FOR TEN YEARS Deaths 300, /4 2004/5 2005/6 2006/7 250, /8 2008/9 2009/ / / /13 100, , ,000
3 WHY IS THIS IMPORTANT? The NHS should use mortality rate indicators such as the Hospital Standardised Mortality Ratio or suitable alternatives as one of its ways to detect potentially severe performance defects that are worth investigating further. A promise to learn a commitment to act (The Berwick Review), August THINK ABOUT THE CONTEXT IN WHICH THESE HOSPITALS WORK
4 RISK ADJUSTMENT HIGHLIGHTING HOSPITALS WHAT ARE THE DIFFERENT MEASURES OF MORTALITY? INTERROGATING THE INFORMATION BRINGING THE DATA TOGETHER The first thing we need to know to create a mortality measure is the reason or diagnosis for which the patient was admitted to hospital. HIGHEST CRUDE MORTALITY cardiac arrest and 53% ventricular fibrillation 0.2% All hospitals treat different patients, some have older patients and some have patients more likely to have a serious condition. In 2012/13 we have included 12 different factors in our main way of measuring deaths in hospital (which we call the Hospital Standardised Mortality Ratio or ). MOST IMPORTANT FACTORS C-STATISTIC? AGE UNDERLYING HEALTH CONDITIONS (COMORBIDITIES) PLANNED/UNPLANNED ADMISSION LOWEST CRUDE MORTALITY abdominal pain AVERAGE C-STATISTIC 0.71 C-STATISTIC The C-statistic tells you the degree to which each factor predicts the death of the patient. A statistic of 1 for age would mean that age completely determined whether or not the patient died. A statistic of 0.5 would mean there was no connection between age and the likelihood of death. We then put hospitals into groups to highlight where the variation in mortality rate is unlikely to be due to chance. These are the hospitals where the data suggests there may be problems (high rates) or better standards of care (low rates). hospital trusts where hsmr is significantly higher than expected Blackpool Teaching Hospitals NHS Foundation Trust Burton Hospitals NHS Foundation Trust George Eliot Hospital NHS Trust Heart of England NHS Foundation Trust Medway NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust North Cumbria University Hospitals NHS Trust North Tees and Hartlepool NHS Foundation Trust Northern Lincolnshire and Goole Hospitals NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust Salisbury NHS Foundation Trust Sherwood Forest Hospitals NHS Foundation Trust South Tees Hospitals NHS Foundation Trust United Lincolnshire Hospitals NHS Trust University Hospitals Birmingham NHS Foundation Trust West Hertfordshire Hospitals NHS Trust EXPLORE THE TRUST DATA AT hospital trusts where hsmr is significantly lower than expected Airedale NHS Foundation Trust Ashford and St Peter s Hospitals NHS Foundation Trust Barnet and Chase Farm Hospitals NHS Trust Barts Health NHS Trust Cambridge University Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust Dartford and Gravesham NHS Trust East Kent Hospitals University NHS Foundation Trust Epsom and St Helier University Hospitals NHS Trust Frimley Park Hospital NHS Foundation Trust Guy s and St Thomas NHS Foundation Trust Hull and East Yorkshire Hospitals NHS Trust Imperial College Healthcare NHS Trust Ipswich Hospital NHS Trust James Paget University Hospitals NHS Foundation Trust King s College Hospital NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Mid Staffordshire NHS Foundation Trust North Middlesex University Hospital NHS Trust North West London Hospitals NHS Trust Plymouth Hospitals NHS Trust Royal Free London NHS Foundation Trust Salford Royal NHS Foundation Trust St George s Healthcare NHS Trust The Whittington Hospital NHS Trust University College London Hospitals NHS Foundation Trust University Hospitals Bristol NHS Foundation Trust West Suffolk NHS Foundation Trust There are many ways to measure mortality. It is important to consider the following questions. hospital trusts with potential problems after an operation possibly went wrong How many patients died from the groups of diagnoses where 80% of deaths occur? Measured using the. How many patients died in each hospital site and what happens if we remove patients in community or longer-term care? Measured using our site-level and the excluding community care. What happens to patients at the end of their life? Tracked by looking at palliative care rates. What happens if we include patients who died soon (within 30 days) after leaving hospital? Measured using the Summary Hospital-level Mortality Indicator (). How many patients died after an operation possibly went wrong? Measured using our Deaths after Surgery indicator. How many patients died who had a condition with a low immediate risk of death? Measured using our Deaths in Low-risk Conditions indicator. Hull and East Yorkshire Hospitals NHS Trust King s College Hospital NHS Foundation Trust University Hospital of North Staffordshire NHS Trust University Hospital of South Manchester NHS Foundation Trust University Hospitals Birmingham NHS Foundation Trust hospital trusts with very good results following surgery Guy s and St Thomas NHS Foundation Trust North Middlesex University Hospital NHS Trust Northern Devon Healthcare NHS Trust Sheffield Teaching Hospitals NHS Foundation Trust Warrington and Halton Hospitals NHS Foundation Trust What happens if we: 10 EXCLUDE COMMUNITY BEDS ONE TRUST IMPROVES ITS BANDING LOOK AT INDIVIDUAL HOSPITALS WITHIN A HOSPITAL TRUST TRUSTS HAVE ONE OR MORE HOSPITALS WITH A RATE HIGHER THAN THE OVERALL TRUST 14 EXAMINE PALLIATIVE CARE RATES TRUSTS HAVE ONE OR MORE HOSPITALS WITH A LOWER RATE THAN THE OVERALL TRUST RATES OF PALLIATIVE CARE VARY FROM 1.2% TO 43.2% ADJUSTING FOR RATES OF PALLIATIVE CARE MAKES A SIGNIFICANT DIFFERENCE TO MORTALITY (AS MEASURED BY THE ) FOR 29 TRUSTS percentage of deaths in hospital where the patient has been identified as receiving palliative care 1.2% (lowest palliative care rate) Taunton and Somerset NHS Foundation Trust 43.2% (highest palliative care rate) East and North Hertfordshire NHS Trust The trusts listed are either high or low across more than one measure of mortality. the following trusts are high on at least two of our four main measures (and are not low on any) Aintree University Hospital NHS Foundation Trust Blackpool Teaching Hospitals NHS Foundation Trust East Sussex Healthcare NHS Trust Heart of England NHS Foundation Trust Medway NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust North Cumbria University Hospitals NHS Trust North Tees and Hartlepool NHS Foundation Trust Northern Lincolnshire and Goole Hospitals NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust United Lincolnshire Hospitals NHS Trust University Hospitals Birmingham NHS Foundation Trust* West Hertfordshire Hospitals NHS Trust * High on three out of four our main measures are: Deaths after Surgery Deaths in Low-risk Conditions the following trusts are low on two or more of our four main measures (and are not high on any) Barnet and Chase Farm Hospitals NHS Trust Barts Health NHS Trust Cambridge University Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust* Frimley Park Hospital NHS Foundation Trust* Guy s and St Thomas NHS Foundation Trust** Imperial College Healthcare NHS Trust James Paget University Hospitals NHS Foundation Trust Leeds Teaching Hospitals NHS Trust North Middlesex University Hospital NHS Trust* North West London Hospitals NHS Trust Northern Devon Healthcare NHS Trust Royal Free London NHS Foundation Trust Salford Royal NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust St George s Healthcare NHS Trust The Whittington Hospital NHS Trust University College London Hospitals NHS Foundation Trust University Hospitals Bristol NHS Foundation Trust West Suffolk NHS Foundation Trust * Low on three out of four ** Low on all four FIND MORE INFORMATION ABOUT MORTALITY RATES AT
5 (KEEP YOUR FINGER ON IT) NHS Acute Trust ex. community patients Deaths in low risk conditions Deaths after surgery Palliative care rate Aintree University Hospital NHS Foundation Trust n/a Airedale NHS Foundation Trust n/a Ashford and St Peter s Hospitals NHS Foundation Trust n/a Barking, Havering and Redbridge University Hospitals NHS Trust Barnet and Chase Farm Hospitals NHS Trust Barnsley Hospital NHS Foundation Trust n/a Barts Health NHS Trust Basildon and Thurrock University Hospitals NHS Foundation Trust n/a Bedford Hospital NHS Trust n/a Blackpool Teaching Hospitals NHS Foundation Trust n/a Bolton NHS Foundation Trust n/a Bradford Teaching Hospitals NHS Foundation Trust n/a Brighton and Sussex University Hospitals NHS Trust Buckinghamshire Healthcare NHS Trust Burton Hospitals NHS Foundation Trust n/a Calderdale and Huddersfield NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust n/a Central Manchester University Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust n/a Chesterfield Royal Hospital NHS Foundation Trust n/a City Hospitals Sunderland NHS Foundation Trust n/a Colchester Hospital University NHS Foundation Trust Countess of Chester Hospital NHS Foundation Trust n/a County Durham and Darlington NHS Foundation Trust Croydon Health Services NHS Trust n/a Dartford and Gravesham NHS Trust n/a Derby Hospitals NHS Foundation Trust n/a Doncaster and Bassetlaw Hospitals NHS Foundation Trust Dorset County Hospital NHS Foundation Trust n/a Ealing Hospital NHS Trust n/a East and North Hertfordshire NHS Trust East Cheshire NHS Trust n/a East Kent Hospitals University NHS Foundation Trust East Lancashire Hospitals NHS Trust n/a East Sussex Healthcare NHS Trust Epsom and St Helier University Hospitals NHS Trust Frimley Park Hospital NHS Foundation Trust n/a Gateshead Health NHS Foundation Trust n/a George Eliot Hospital NHS Trust n/a Gloucestershire Hospitals NHS Foundation Trust Great Western Hospitals NHS Foundation Trust n/a Guy s and St Thomas NHS Foundation Trust n/a Hampshire Hospitals NHS Foundation Trust Harrogate and District NHS Foundation Trust n/a Heart of England NHS Foundation Trust Heatherwood and Wexham Park Hospitals NHS Foundation Trust n/a Hinchingbrooke Health Care NHS Trust n/a Homerton University Hospital NHS Foundation Trust n/a Hull and East Yorkshire Hospitals NHS Trust n/a Imperial College Healthcare NHS Trust Ipswich Hospital NHS Trust n/a Isle of Wight NHS Trust n/a James Paget University Hospitals NHS Foundation Trust n/a Kettering General Hospital NHS Foundation Trust n/a King s College Hospital NHS Foundation Trust n/a Kingston Hospital NHS Trust n/a Lancashire Teaching Hospitals NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Lewisham Healthcare NHS Trust n/a Luton and Dunstable Hospital NHS Foundation Trust n/a Maidstone and Tunbridge Wells NHS Trust Medway NHS Foundation Trust n/a Mid Cheshire Hospitals NHS Foundation Trust n/a Mid Essex Hospital Services NHS Trust n/a Mid Staffordshire NHS Foundation Trust n/a Mid Yorkshire Hospitals NHS Trust Milton Keynes Hospital NHS Foundation Trust n/a Norfolk and Norwich University Hospitals NHS Foundation Trust n/a North Bristol NHS Trust n/a North Cumbria University Hospitals NHS Trust North Middlesex University Hospital NHS Trust n/a excl. community care Site-level variance Deaths in Low-risk Conditions Deaths after Surgery Palliative care (%) NHS Acute Trust ex. community patients excl. community care Site-level variance Deaths in low risk conditions Deaths after surgery Palliative care rate North Tees and Hartlepool NHS Foundation Trust North West London Hospitals NHS Trust Northampton General Hospital NHS Trust n/a Northern Devon Healthcare NHS Trust n/a Northern Lincolnshire and Goole Hospitals NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust Nottingham University Hospitals NHS Trust Oxford University Hospitals NHS Trust Pennine Acute Hospitals NHS Trust Peterborough and Stamford Hospitals NHS Foundation Trust n/a Plymouth Hospitals NHS Trust n/a Poole Hospital NHS Foundation Trust n/a Portsmouth Hospitals NHS Trust n/a Royal Berkshire NHS Foundation Trust n/a Royal Cornwall Hospitals NHS Trust n/a Royal Devon and Exeter NHS Foundation Trust n/a Royal Free London NHS Foundation Trust n/a Royal Liverpool and Broadgreen University Hospitals NHS Trust n/a Royal Surrey County Hospital NHS Foundation Trust n/a Royal United Hospital Bath NHS Trust n/a Salford Royal NHS Foundation Trust n/a Salisbury NHS Foundation Trust n/a Sandwell and West Birmingham Hospitals NHS Trust Sheffield Teaching Hospitals NHS Foundation Trust Sherwood Forest Hospitals NHS Foundation Trust n/a Shrewsbury and Telford Hospital NHS Trust South Devon Healthcare NHS Foundation Trust n/a South London Healthcare NHS Trust South Tees Hospitals NHS Foundation Trust South Tyneside NHS Foundation Trust n/a South Warwickshire NHS Foundation Trust n/a Southend University Hospital NHS Foundation Trust n/a Southport and Ormskirk Hospital NHS Trust n/a St George s Healthcare NHS Trust n/a St Helens and Knowsley Hospitals NHS Trust n/a Stockport NHS Foundation Trust n/a Surrey and Sussex Healthcare NHS Trust n/a Tameside Hospital NHS Foundation Trust n/a Taunton and Somerset NHS Foundation Trust n/a The Dudley Group NHS Foundation Trust n/a The Hillingdon Hospitals NHS Foundation Trust n/a The Newcastle Upon Tyne Hospitals NHS Foundation Trust The Princess Alexandra Hospital NHS Trust n/a The Queen Elizabeth Hospital, King s Lynn, NHS Foundation Trust n/a The Rotherham NHS Foundation Trust n/a The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust n/a The Royal Wolverhampton NHS Trust n/a The Whittington Hospital NHS Trust n/a United Lincolnshire Hospitals NHS Trust University College London Hospitals NHS Foundation Trust n/a University Hospital of North Staffordshire NHS Trust n/a University Hospital of South Manchester NHS Foundation Trust n/a University Hospital Southampton NHS Foundation Trust n/a University Hospitals Birmingham NHS Foundation Trust n/a University Hospitals Bristol NHS Foundation Trust University Hospitals Coventry and Warwickshire NHS Trust n/a University Hospitals of Leicester NHS Trust * University Hospitals of Morecambe Bay NHS Foundation Trust Walsall Healthcare NHS Trust n/a Warrington and Halton Hospitals NHS Foundation Trust n/a West Hertfordshire Hospitals NHS Trust n/a West Middlesex University Hospital NHS Trust n/a West Suffolk NHS Foundation Trust n/a Western Sussex Hospitals NHS Trust Weston Area Health NHS Trust n/a Wirral University Teaching Hospital NHS Foundation Trust n/a Worcestershire Acute Hospitals NHS Trust Wrightington, Wigan and Leigh NHS Foundation Trust n/a Wye Valley NHS Trust n/a Yeovil District Hospital NHS Foundation Trust n/a York Teaching Hospital NHS Foundation Trust Deaths in Low-risk Conditions Deaths after Surgery Palliative care (%) Trusts higher than expected Trusts lower than expected Trusts within expected 1 One site-level is higher than the trust 1 One site-level is lower than the trust Site-level s are both higher and lower than the trust * Data not available Site-level s are no different to the trust n/a Not applicable Deaths per 1,000 patients To learn more, visit
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