Published Fri, 2010-11-26 18:09; updated 34 weeks ago.
Five hospital trusts in the West Midlands have been found to have recorded a higher than expected mortality rate, according to a survey by an independent healthcare group.
The study, by Dr Foster Intelligence, revealed that The Royal Wolverhampton Hospitals NHS Trust, George Eliot Hospital NHS Trust in Nuneaton, The Dudley Group of Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, and University Hospitals Birmingham NHS Foundation Trust, had recorded a higher than expected rate of Hospital Standardised Mortality Ratios (HSMRs).
However Mid Staffordshire NHS Foundation Trust, currently the subject of a public inquiry into standards of care at Stafford Hospital, has seen mortality rates fall significantly since investigators began to look at the trust two years ago. Its mortality rate is now lower than the national average.
A second analysis of mortality rates in the guide looked at deaths among patients who had surgery and a medical complication such as an infection. Both University Hospitals Birmingham and University Hospital of North Staffordshire NHS Trust were found to have higher than expected levels of mortality on this measure.
But University Hospitals NHS Foundation Trust disputed the figures, saying their hospitals were "extremely safe places to be treated and to have surgery."
Medical Director Dr Dave Rosser said: "The Trust monitors its death rates on a daily, weekly and monthly basis and it refutes the mortality rates and death rates after surgery produced by Dr Foster.
"We believe there is a risk that figures like these could cause unnecessary confusion and distress amongst patients and are a distraction to concentrating on providing the best in care for our patients."
Dr Rosser said the methodology for reaching their "hypothetical" figure was fundamentally flawed and misleading to the public.
"We treated over 90,000 inpatients in 2009-2010, 1,299 of whom died in our hospitals last year. Dr Foster’s methodology inflates the number of deaths, by such factors as attributing one death to multiple hospitals. These adjustments would take the number of deaths to 1,409.
"However Dr Foster has calculated our mortality rates based on 1,507 deaths (ie 208 deaths more than actually occurred).
"The Trust has been working with the Imperial College Dr Foster Unit, who are currently unable to explain how they have attributed 102 of those deaths to the Trust."
Dr Rosser also claimed that the Dr Foster ‘deaths after surgery’ indicator is "destructive and unhelpful."
He added: "For example, many patients come to the Queen Elizabeth Hospital’s regional liver unit with oesophageal varices, a condition often associated with alcoholic liver disease. More than 50% of patients die from this condition worldwide, even in the very best hospitals.
"As a specialist liver unit, in the majority of cases, doctors at the QEHB will carry out a procedure to try to save a patient’s life. However, the way this indicator is constructed, those patients who will die, despite the intervention, will still contribute to a high score on this indicator.
"This indicator could put significant pressure on medical staff not to carry out procedures that would potentially save the lives of high-risk patients because they would be counted as unexpected deaths.
"We take any death of a patient in our hospitals very seriously and have a very robust and sophisticated system in place for monitoring them."
He said the Care Quality Commission, which regulates clinical standards across NHS hospitals, was satisfied that there were no causes for concern regarding their mortality rates or deaths after surgery.
Dr Rosser added that, following a Government directive, a new measure for hospital mortality has been nationally agreed and is due to be introduced from April 2011.
The Royal Wolverhampton Hospitals NHS Trust said safety and quality of patient care were at the heart of everything it does.
Chief executive David Loughton said “Patients can be reassured that we rigorously monitor the rates of mortality in this hospital to identify if any action needs to be taken to improve the care we offer our patients.”
He said the Trust’s own detailed analysis shows that its death rates have stayed level for a number of years, despite sharp rises in the amount of patients choosing to come to its hospital from other neighbouring regions.
The Trust board was satisfied that each mortality was risk assessed, the explanations explored and appropriate actions taken by the clinical team to ensure the safety of patients.
“I would like to reassure our patients that we will continue to look for improvements. We will continue to challenge our clinical practice so that our services are even safer,” Mr Loughton added.
Roger Taylor, Director of Research at Dr Foster, said: "Mortality rates are just one indicator of hospital outcomes and should not be looked at in isolation. The hospital guide looks at 25 measures of hospital performance. However where hospitals do have high mortality rates, it may indicate issues with standards of care. The figures should prompt hospital trusts to investigate the causes of high rates of deaths."
The Dr Foster Hospital Guide found that HSMRs are decreasing, with only 19 of the 147 hospitals trusts now having significantly high HSMRs, compared with 27 last year. A total of 26 trusts had significantly low HSMRs, including Mid Staffordshire.
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