Hospital deaths to be reviewed

By Ian Dipple Friday 04 July 2014 Updated: 07/07 12:01

DEATHS within the county's hospitals will be reviewed following a spike in mortality rates.

Worcestershire Acute Hospitals NHS Trust has instigated the move due to concerns about its rising HSMR (Hospital Standardised Mortality Ratio) indicator.

The HSMR is one way hospitals measure death rates taking into account factors outside of their control such as severity of disease, age, sex and the effect of simultaneous diseases and disorders, known as comorbidities.

A score of 100 means the numbers of people losing their life in hospital is about the expected level, but if it is too high or too low it could indicate a problem.

As of March, WAHT's HSMR was 108 putting it close to the limit of what would be considered normal.

Doctors have been reviewing the notes of patients who have died in key groups, such as those with pneumonia, to try and understand why the rate is rising.

But Dr Steve Graystone, medical director of patient safety, told a board meeting last Wednesday (June 25) it was the equivalent of 'driving forward while looking in the rear view mirror'.

Instead from this month a real time review of patient deaths will be carried out involving senior clinicians, to look at every aspect of how a patient was cared for. It will also examine how the conditions recorded against patients are classified - or coded - to ensure they are accurate.

But Dr Graystone stressed a high HSMR did not automatically mean there was a problem with the standard of care although they would be looking for opportunities to improve quality as part of the review.

"To make a link between a high HSMR and overall quality of care is tenuous at best but it's certainly a metric used to understand what is happening in our organisation," he said.

"We are taking this metric seriously but a single dot on a graph, which it is, does not necessarily reflect on our overall quality of care."

Prof Julion Bion, Trust non-executive director and chair of the quality and governance committee, said the SHMI (Summary Hospital-level Mortality Indicator), which includes patients who died within 30 days of discharge from hospital, was a better indicator and was within range at 102.

He suggested the HSMR may be high because of a combination of factors including delayed discharges and inaccurate coding.

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