National hospital mortality surveillance system: a descriptive analysis

Elizabeth Cecil; Samantha Wilkinson; Alex Bottle; Aneez Esmail; Charles Vincent; Paul P Aylin

doi:10.1136/bmjqs-2018-008364

National hospital mortality surveillance system: a descriptive analysis

BMJ Qual Saf. 2018 Dec;27(12):974-981. doi: 10.1136/bmjqs-2018-008364. Epub 2018 Oct 8.

Authors

Elizabeth Cecil¹, Samantha Wilkinson², Alex Bottle³, Aneez Esmail⁴, Charles Vincent⁵, Paul P Aylin³

Affiliations

¹ Primary Care and Public Health, Imperial College London, London, UK e.cecil@imperial.ac.uk.
² Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
³ Primary Care and Public Health, Imperial College London, London, UK.
⁴ Health Services Research and Primary Care, University of Manchester, Manchester, UK.
⁵ Experimental Psychology, University of Oxford, Oxford, UK.

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.

Keywords: hospital mortality; quality of care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
England
Health Care Surveys / methods
Hospital Mortality / trends*
Hospitalization / statistics & numerical data
Humans
Quality of Health Care / standards*
Retrospective Studies
State Medicine / organization & administration*

Grants and funding

12/178/22/DH_/Department of Health/United Kingdom