News and updates from Hospital Mortality Annual Summit
Today's annual summit focuses on the question of mortality monitoring: where are we now? Through national updates and practical case studies the conference looks at how we can reduce and monitor avoidable deaths in hospitals through a range of measures which will replace the single hospital wide HSMR approach. The various approaches will aim to answer the question of whether a problem in care contributed to death, and how to identify which deaths attributable to problems in care are unavoidable.
Following the chair's welcome, Dr Helen Hogan Clinical Lecturer in UK Public Health/Course Director London School of Hygiene and Tropical Medicine will open the conference with a presentation on 'Mortality Monitoring: Where are we now and what is the evidence?', focusing on:
• mortality monitoring: where are we now?
• measuring avoidable deaths: case note review and hospital-wide mortality ratios
• looking forward: new ways to look at harm, mortality and avoidable deaths
• engaging clinicians in assessing the safety of their care to stimulate improvement
• an update on the national mortality review programme
Dr Helen Hogan Full Presentation Click Here
In her Presentation Dr Helen Hogan stated:
Limitations of avoidable deaths as a measure of quality – quite a small number so difficult to study, hospitals are complex so no one measure can measure quality across a hosp, difficult to judge if a death was avoidable (most hosp deaths are elderly with co-morbidity), some problems may occur ‘upstream’ of the hospital, changing base line as technology advances.
What are we using to measure avoidable death? Routine data, hospital wide standardized mortality ratios, coded adverse events linked to death, known avoidable harms and attributable death rates and extrapolate to populations, prospective surveillance systems.
Public and policy interest in hospital death rates has risen sharply, particularly following the investigation into the Mid Staffordshire NHS Trust and the investigation into 14 other acute Trusts around the country (Keogh Review).
There are a range of information sources on deaths in NHS hospitals, all of which have advantages and disadvantages to their use. The Department of Health (DH) has advocated the use of hospital-wide measures of mortality such as HSMR and SHMI to provide an early warning system of quality and safety problems within hospitals and to compare performance across hospitals. However, intense debate surrounds whether the "excess deaths" detected by these measures are a valid indicator of the safety of a hospital and actually represent “avoidable deaths”. Many factors beyond patient safety impact on these measures including how well coded patient diagnoses are within hospital administration systems or whether there is adequate provision of alternative facilities and services to care for those approaching death in the geographical area to avoid terminally ill patients dying in hospital. These factors can lead to higher scores for some hospitals which may not be accounted for by poorer quality and safety standards.
Dr Helen Hogan's biography
Dr Helen Hogan BSc, MB BS, PhD, MRCGP, FPH Associate Professor in UK Public Health, London School of Hygiene and Tropical Medicine
I trained as a GP before undertaking specialty training in public health. Since joining LSHTM in September 2006 my main research interest has been patient safety in acute care and I have undertaken a number of studies in collaboration with colleagues from the Centre for Patient Safety and Service Quality at Imperial College and the former National Patient Safety Agency. I was chief investigator for the Preventable Incidents, Survival and Mortality studies (PRISM 1 and 2), retrospective case record reviews of 3400 adult deaths across 34 English Hospitals. The approach and findings from these studies are informing the design of the new national mortality review programme. Ongoing studies are looking at the measurement of healthcare-related severe harm and the effectiveness of interventions to prevent patient deterioration in the ward setting.
Also of interest
Learning from Serious Incidents: Implementing the CQC Recommendations
Wednesday 7 December 2016
Hallam Conference Centre, London
20 October 2016