A national hospital mortality surveillance system: a descriptive analysis

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Title: A national hospital mortality surveillance system: a descriptive analysis
Authors: Cecil, EV
Wilkinson, S
Bottle, R
Esmail, A
Vincent, C
Aylin, P
Item Type: Journal Article
Abstract: Objective To provide a description of the Imperial College Mortality Surveillance System and subsequent investigations by the Care Quality Commission (CQC) in National Health Service (NHS) hospitals receiving mortality alerts. Background The mortality surveillance system has generated monthly mortality alerts since 2007, on 122 individual diagnosis and surgical procedure groups, using routinely collected hospital administrative data for all English acute NHS hospital trusts. The CQC, the English national regulator, is notified of each alert. This study describes the findings of CQC investigations of alerting trusts. Methods We carried out (1) a descriptive analysis of alerts (2007–2016) and (2) an audit of CQC investigations in a subset of alerts (2011–2013). Results Between April 2007 and October 2016, 860 alerts were generated and 76% (654 alerts) were sent to trusts. Alert volumes varied over time (range: 40–101). Septicaemia (except in labour) was the most commonly alerting group (11.5% alerts sent). We reviewed CQC communications in a subset of 204 alerts from 96 trusts. The CQC investigated 75% (154/204) of alerts. In 90% of these pursued alerts, trusts returned evidence of local case note reviews (140/154). These reviews found areas of care that could be improved in 69% (106/154) of alerts. In 25% (38/154) trusts considered that identified failings in care could have impacted on patient outcomes. The CQC investigations resulted in full trust action plans in 77% (118/154) of all pursued alerts. Conclusion The mortality surveillance system has generated a large number of alerts since 2007. Quality of care problems were found in 69% of alerts with CQC investigations, and one in four trusts reported that failings in care may have an impact on patient outcomes. Identifying whether mortality alerts are the most efficient means to highlight areas of substandard care will require further investigation.
Issue Date: 1-Dec-2018
Date of Acceptance: 5-Sep-2018
ISSN: 2044-5415
Publisher: BMJ Publishing Group
Start Page: 974
End Page: 981
Journal / Book Title: BMJ Quality and Safety
Volume: 27
Copyright Statement: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Dr Foster Intelligence
Funder's Grant Number: 12/178/22
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
hospital mortality
quality of care
Publication Status: Published
Online Publication Date: 2018-10-08
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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