New hospital mortality indicator to improve measurement of patient safety

New information on mortality rates in NHS hospitals has been published as part of plans to give patients and the public more transparent and robust information about their local NHS.


The new Summary Hospital-level Mortality Indicator (SHMI) compares the actual number of patients who die following treatment at a trust with the number who would be expected to die, given the characteristics of the patients treated there.

For the first time, it considers all deaths that take place both in hospital and within 30 days of discharge, offering a more comprehensive picture of deaths following hospital care.

The SHMI shows mortality rates for every acute non-specialist trust in England - providing a single comprehensive indicator that will be used consistently across the NHS. It will also highlight trusts with the lowest mortality which can provide valuable learning on how quality of care can be improved.

Each trust has a single SHMI value but the data has been published with two different methods of categorising trusts as having as expected, higher than expected and lower than expected mortality rates. One method reduces the potential for falsely identifying borderline trusts as higher than expected, and therefore identifies fewer trusts as higher or lower than expected. The other method is more sensitive, identifying more trusts as higher or lower than expected.

The data shows:

the vast majority of trusts have a mortality rate that falls within an expected range 119 using the less sensitive control limits and 79 using the more sensitive control limits
for Trusts with higher than expected mortality, 14 outliers are identified using the less sensitive control limits and 36 using the more sensitive control limits
14 trusts have lower than expected mortality using the less sensitive control limits and 32 Trusts for the more sensitive control limits.

Health Secretary Andrew Lansley said:

We are determined to improve patient safety and shine a light on poor performance by giving patients, public and the NHS more robust information about their hospital trust.

As I have highlighted this week, we are doing all we can to improve care for patients and help turn around struggling hospitals.

This new measure will help ensure patient safety by acting like a smoke alarm to prompt further investigation. Alongside other data, this will help the NHS in future to spot and act on poor care as soon as possible. We are determined to learn the lessons of the appalling events at Mid Staffordshire this data will help us avoid a repeat of that tragedy.

"A more transparent NHS is a safer NHS where patients can be confident of receiving high quality care.

NHS Medical Director Professor Sir Bruce Keogh, who commissioned the review of mortality indicators on behalf of the National Quality Board, said:

The SHMI adds to our understanding of hospital mortality, but no one indicator alone can give us a complete picture of a hospitals performance.

For example, no-one would buy a car based only on the mileage or how many miles you get to the gallon you would look at lots of information before making a decision. In the same way, to truly understand the quality of care at a hospital, you must look at this alongside other information.

All hospital trusts, regardless of whether they are outliers, need to examine, understand and explain their SHMI and identify where performance may be falling short. Trusts with a low mortality rate could also provide valuable learning about how quality of care can be improved.

Hospital mortality ratios are complex indicators which have prompted international debate about their definition and interpretation. The Francis Review into Mid Staffordshire NHS Foundation Trust recognised the uncertainty this debate was causing and recommended a national review into hospital mortality ratios so that variations and trends associated with hospital deaths could be better understood. That review was carried out by a wide range of the experts and reached a consensus on SHMI as a new indicator.

The indicator is still new and experimental - refinements will have to be made in the future. No statistical model can ever perfectly estimate the risk of mortality.

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