The recently released 2013 Dr Foster Hospital Guide considers many factors affecting NHS Trusts throughout the UK, including mortality rates. The Dr Foster Guide, put together by a highly respected research unit at Imperial College in London, has published mortality figures for over 10 years, and it is important to know how mortality rates and collected and measured, and what baseline these figures should be compared against.
Measuring Mortality in the NHS
In the most basic terms, mortality comparison involves taking the total number of deaths which happen in a specific hospital or NHS Trust, and comparing the figure to the numbers of deaths happening in other areas of the country. In order to make the comparison meaningful, researchers compare groups of patients with similar conditions to get an accurate result. Mortality reports comparing deaths of similar patients in different hospitals can give indications of which hospitals need to improve.
Dr Foster goes through the following process to calculate the mortality rates around the UK.
1. A count is done of the total number of hospital patients who have died during the time period under consideration.
2. As many as 12 additional factors such as the types of patients treated in a hospital, their illnesses or age are taken into account.
3. The hospital’s own Hospital Standardised Mortality Rate (HSMR) is used. This figure calculates how many patients would have been expected to die over the time period, taking into account all of the above factors such as age and type of illness.
4. The hospitals are then banded depending on how well or how poorly they are performing on mortality rates.
The process is very complex, and in addition to considering the raw data the research group looks at things such as patients who have died during surgery, those who die within a month of leaving hospital after treatment, the age of the patients being treated, whether they suffered from any underlying medical conditions, and if they were admitted to hospital as an emergency or for a routine procedure.
All mortality rate studies depend on the hospital providing accurate coding information to the researchers about their patients. If details such as infections or complications during treatment are not properly noted, this could lead to the figures being skewed.
Dr Foster Findings
There are many findings which can be taken from the 2013 Dr Foster report. In absolute terms, just over 237,000 patients died in hospital during 2013, which is the second lowest death rate in ten years. The report also shows that death figures are not declining in a steady pattern; 2013’s figures were better than in 2010/11, but more than in 2011/12.
There is also a differing picture across the country. Using the HSMR figures, 16 NHS Trusts have higher mortality rates than might have been expected, and 29 Trusts have lower rates. There is a lot more detail in the full report which is available on the Dr Foster website, and this detail should be used by all NHS Trusts to identify which areas of their hospitals need to be improved. Understanding failings and acting on them should lead to mortality rates dropping even further in the future.
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