Monitoring of hospital mortality rates
The Trust recognises the importance of considering key mortality data, in particular Hospital Standardised Mortality Ratio (HSMR) and Summary Hospital-level Mortality Indicator (SHMI). Regular monitoring of such matrices is firmly embedded within Trust’s culture at Specialty, Divisional, Sub-Committee and Board level. Key headline mortality data and is provided to Mortality Surveillance Committee, and both the Quality and Safety Committee and Board (via the quarterly Mortality Report).
It is acknowledged that the relationship between mortality rates and the quality of patient care is a complex one. For this reason, an elevated mortality rate is the trigger for further investigation, understanding that it may not indicate any deficiency in the quality of care provided. The Trust seeks to ensure the triangulation of available information from many sources including mortality data, structured judgement mortality reviews, coding reviews, and in some cases, care in the community in the formulation of its quality improvement work.
Crude mortality rate
A hospital’s crude mortality rate looks at the number of deaths that occur in a hospital in any given year and then compares that against the amount of people admitted for care in that hospital for the same time period. The crude mortality rate can then be set as the number of deaths for every 100 patients admitted.
Hospital standardised mortality ratio (HSMR)
While crude mortality rates are important, it is very hard to use this information to compare and contrast what’s happening between hospitals. This is because every hospital is different, both in the treatments and operations that it offers and the make-up of its local population. The hospital standardised mortality ratio (HSMR) was developed to enable a more meaningful comparison of mortality rates between hospitals. The HSMR scoring system works by taking a hospital’s crude mortality rate and adjusting it for a variety of factors – population size, age profile, level of poverty, range of treatments and operations provided, etc. Nationally the expected HSMR score for hospitals is set as being 100. A score of 100 means that the number of deaths is similar to what you would expect. A lower score means less deaths, a higher score means more deaths.
Summary hospital-level mortality indicator (SHMI)
The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. In many ways it is therefore similar to HSMR, although different variable factors are taken in to account in calculating the scores. Key differences are that SHMI includes deaths following a patient’s discharge (within 30 days) and does not make an adjustment for palliative care. First published in October 2011, while SHMI was historically published on a quarterly basis, since January 2019 it has been reported monthly.
Learning from Deaths
In December 2016 the CQC published its report ‘Learning, Candour and Accountability: A review of the way NHS Trusts review and investigate the deaths of patients in England’. Commissioned by the Secretary of State for Health in response to the very low number of investigations and reviews of deaths at Southern Health NHS Foundation Trust, it concluded that opportunities to improve care for future patients were being missed due to insufficient consideration being paid to learning from deaths in the NHS.
The Secretary of State accepted the report’s recommendations, asking the National Quality Board (NQB) to translate the recommendations into a framework for implementation across the NHS. In March 2017 the first step in this programme was published in the form of the National Guidance on Learning from Deaths.
In line with this guidance our Trust’s Learning from Deaths policy was first published in October 2017. This policy seeks to build on previous Trust policies relating to mortality review, investigation and bereavement while at the same time incorporating new requirements from the national guidance.
Information can also be found in the Trust’s annual Quality Account and in quarterly Summary Learning from Deaths Board reports.