Experts Agree New Mortality Indicator for the NHS

Published on Monday, 08 November 2010 09:28
Posted by Scott Buckler

The method for calculating and using hospital mortality ratios across the NHS in England will change following a national review


The new method, published today by the NHS National Quality Board, is called the Summary Hospital-level Mortality Indicator (SHMIs). The indicator can be used by hospitals to help them better understand trends associated with patient deaths.

Hospital mortality ratios are complex indicators, and there has been international debate over how they should be calculated and used. The variation among existing methodologies and the complex nature of the issue has also caused confusion among NHS managers, clinicians and patients.

The Francis Review into Mid Staffordshire NHS Foundation Trust shed new light on this debate and recommended a national review so that variations and trends associated with hospital deaths could be better understood.

This resulting review, led by Ian Dalton as Chief Executive of NHS North East, was carried out by a wide range of the experts on mortality ratios and relevant organisations. These include the Academy of Royal Colleges, the Care Quality Commission, the NHS Confederation, Dr Foster Intelligence, CHKS, National Patient Safety Agency and Professor Sir Brian Jarman from Imperial College.

The review group reached a consensus on the best methodology for the NHS to use and how to use it. It found that an SHMI is only one of a number of indicators that provides information about a hospital and its quality. While it can help to shine a light on potential areas for further analysis or investigation, it cannot be used as a standalone indication of quality or to rank hospitals in crude league tables.

Instead, the SHMI is like a trigger or smoke alarm - they may go off when there is no fire to put out, but they can also indicate a serious problem and must always be examined. Hospital boards must consider their scores carefully and ensure that they are continuing to provide the highest standards of care.

The SHMI indicator will:

• help ensure patient safety by providing an early trigger to probe potential problems;
• cover deaths relating to all admitted patients that occur in all settings - including those occurring in hospital and those occurring 30  days post-discharge;
• apply to all NHS acute trusts except specialist hospitals, and
• adjust as far as possible for factors outside of a hospital’s control that might impact on hospital mortality rates.

Professor Sir Bruce Keogh, who commissioned the review on behalf of the National Quality Board, said:

"We are the first country to make a systematic attempt to engage healthcare providers, academics, institutions of medicine and the commercial sector in developing a clear method for assessing expected hospital death rates. The methodology will be open to public and academic scrutiny and debate so that it improves and becomes more useful over time."

Ian Dalton, who chaired the review as Chief Executive of NHS North East and is now the Director of Provider Development at the Department of Health, said:

This is a huge achievement – we now have a wide-ranging consensus not only on the best way to measure mortality but also on how this measure should be used.

“A high SHMI on its own is not an indication of poor standards of care but it is a trigger to take action. Hospital boards across the country have a responsibility to pursue questions the SHMI might raise and quick action will help to ensure safe care for patients at all times.” 

The method will now be subject to rigorous independent testing and analysis before being formally introduced to the NHS by April 2011.

Source: ©DH

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