Progress on hospital mortality rates

A report presented at a public board meeting yesterday state that Sherwood Forest Hospitals NHS Foundation Trust’s HSMR (hospital standardised mortality rate) ‘has been improving for the past six months and is on target to fall to 100 by November 2014’.

The improvements mean that for the first six months of 2013, the trust is no longer an ‘outlier’ for mortality, with the improvements being driven by ‘a genuine reduction in mortality’.

Dr Andy Haynes, interim medical director at Sherwood Forest trust, said that the most recent data confirms that the mortality ratio stands at 115, down from 120 in January.

Improvement

He said: “It is an improvement from the historical position but we would like to see it improve further.

“There’s now a clear focus in the trust from all the staff about the factors that feed into mortality risk and a clear system for reporting mortality to the trust board so we monitor it on a regular basis.”

Sherwood Forest’s high mortality rates were the reason why it was chosen by Sir Bruce Keogh, the NHS’s medical director, for his independent review.

HSMR is the difference between the actual number of deaths at a trust and the number that would be expected, given the characteristics of patients, with a figure of 100 representing the average.

But now the trust has seen an 8.4 per cent drop in crude mortality in emergency admissions between January and August compared with the same time last year, with big improvements seen in the areas of deaths from pneumonia, stroke, heart attack, sepsis and acute kidney failure.

Dr Haynes said that a lot of work has been put in to make sure they understand why patients are dying and from what conditions so that the causes can be better addressed.

“All the areas that have been flagged as areas of concern from 2011-12 have shown an improvement other than one, which is urinary tract infection, and that is being looked at at the moment,” he said.

Systems that have been put in place at King’s Mill to reduce mortality include the introduction of a more effective early warning scheme which recognises more quickly and more effectively when patients are deteriorating so they can be given the treatment they need.

The hi-tech VitalPac system is also being brought in, enabling doctors and nurses to record clinical data on hand-held computers which can be instantly analysed.

This will alert doctors to unusual results, prompting action to be taken at the earliest opportunity.

Work to reduce deaths from sepsis has included a review into patient deaths from the condition, the launch of sepsis boxes on wards and awareness events for staff about blood poisoning.

Dr Haynes said that though the figures presented to the board show an improvement, this will not be recognised in the figures released publicly by Dr Foster at the end of the year because these use older data.

However, the change in the way the trust now monitors mortality rates, using month to month comparisons, will mean that any potential problems will be recognised long before they are officially published.

Dr Haynes added: “We are moving from looking backwards to working forwards and making sure we are doing all that we can to make our patients safe on a day to day basis.”

Ashfield MP Gloria De Piero cautiously welcomed the news.

She said: “I very much welcome the positive progress that has been made and staff deserve a great deal of credit. There is still much more to be done and we cannot be complacent. Bosses still need to ensure there are enough nurses on our wards to deliver safe care and the Trust need to set out exactly what they are doing to ensure our hospital is adequately prepared for the coming winter to prevent another A&E crisis.

“I will continue to monitor situation very closely to ensure that any improvements are maintained.”