In my blog of 28 February I reported on mortality statistics (please see for background). At that time RSCH’s performance according to the national index ‘SHMI’ was good (and still is but according to statistics published by Dr Foster performance was poor. The reason suspected was the way the hospital was coding palliative care. This plus events in Mid-Staffordshire caused the hospital to mount a substantial review by examining the notes of all deaths in 2012, recoding where appropriate and resubmitting the data to Dr Foster for reprocessing. The work was checked by a group of GPs to ensure there was no bias.
The hospital does not use Dr Foster’s services but uses another company CHKS. Recoded data was also sent to them for reprocessing.
The results confirmed that the main reason for the poor results from Dr Foster was substantial undercoding of palliative care ( the criteria and guidance for palliative coding is open to interpretation and this is widely recognised). The position of RSCH compared with other hospitals changed from being near the bottom to approaching the average. Also the results from CHKS changed from around average to very good. The national index SHMI is unaffected by palliative coding and remains good (5 to 10 percent less deaths than expected).
This review has been followed not only by a focus on better coding but also has led to more formalised monthly reviews of statistics and deaths in all specialties and the formation of a top level Mortality Review Committee. This is all good news and will be reassuring to patients, I continue to keep an eye on mortality data and will be interested to see what the next Dr Foster publication has to say – it is due soon.