Thursday, 21 February 2013

Mortality statistics

When I sought election I said I would concentrate on looking at information about clinical outcomes in areas which are life threatening or life changing. One of those areas is mortality statistics. I have spent the last 5 months collecting data on hospitals in the S.E. and getting to grips with the intricacies of the various mortality indices which hospitals use. There are five: one national from the NHS Information Centre (NHSIC) which everybody uses, two from the company Dr Foster  and two from the company CHKS. RSCH uses the CHKS's.

The first thing to say is that having five different indices is a mess. One of the indices from CHKS is terrible (NHSIC agrees) and its meaning is widely misunderstood including within RSCH. I am pleased that RSCH has agreed not to rely solely on this indicator. One of the recommendation from the recent Francis Report on Staffordshire Hospital recognises that it's all a mess and calls for an in-depth review. I intend to do what I can to encourage that review (I will report on that another time).

Pleasingly RSCH is in the top 15% judged by the national NHSIC index (an excellent indicator). Its value indicates that for RSCH deaths are about 10% lower than would be expected. However this index looks at deaths in hospital plus deaths outside within 30 days of discharge. It needs therefore to be used in conjunction with an index or indices which deal solely with deaths occurring within the hospital. For that purpose RSCH uses the two indices from CHKS.

I have examined RSCH's monthly Performance Reports for 2012 to see how it reports on mortality and have looked also at Dr Fosters indices for RSCH and various national data. Just before I was due to discuss what I found with hospital staff:
Ø Dr Foster published its 2012 statistics on mortality;
Ø The Francis Report was published throwing a spotlight on how hospitals handled their mortality statistics (it was Dr Foster's statistics which threw Staffordshire Hospital in to the limelight).

These events have caused a flurry of media interest with the Department of Health announcing an investigation of mortality in a number of hospitals where Dr Foster and NHSIC indices look particularly bad. RSCH is not one of them but, like all hospitals, it has been stimulated to look closely at its figures.

Even though its performance judged by the NHSIC index is very good, its performance judged by the recent Dr Foster publication is not. The hospital is determined to discover why. One of the likely reasons is technical in that, where a patient is receiving palliative
care and thus likely to die, the hospital is failing to capture that fact in its coding of the patient's care episode. Indeed in national statistics RSCH appears to have far fewer deaths coded palliative than the great majority of other hospitals. The affect of this deficiency in coding is to make the mortality index worse than it would be if coding was better.

I have met with the Medical Director and the Chairman of the Board and discussed the reporting on mortality in Performance Reports, NHSIC and Dr Foster's figures and the matter of coding of palliative cases. The meetings have been extremely constructive and results will be fed in to the major review of coding and mortality which the hospital is undertaking in the light of the Dr Foster data and backlash of the Francis Report. Nothing to date leads me to believe that quality of care is poor.  I am being kept in the loop. RSCH will not be the only hospital taking a good look at how it deals with its mortality statistics and that can only be good for patients.

I have also been looking at cancer survival rates – more later.

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