Highest mortality NHS hospitals named

The Dr Foster Hospital Guide 2011 has named two trusts that are consistently recording high mortality rates across a range of indicators.

The guide, published today, has taken into account four different ways of measuring mortality.

They are: the hospital standardised mortality ratio (HSMR), which measures deaths while in hospital; the new summary hospital-level mortality indicator (SHMI), which takes into account deaths in and out of hospital; deaths after surgery; and deaths from conditions that patients would normally survive.

While no trusts were outliers on all four indicators, Hull and East Yorkshire Hospitals NHS Trust and University Hospitals of North Staffordshire NHS Trust were both high on three out of the four.

Hull and East Yorkshire recorded higher than expected in both the HSMR and SHMI measures, as well as the rate of deaths after surgery.

The trust also recorded higher than expected in-hospital deaths last year, which it said was because it had more patients remaining in hospital to die compared to other trusts. However, the new SHMI indicator shows the trust is high on mortality rates whether patients are in or out of hospital.

North Staffordshire also recorded higher than expected numbers of deaths after surgery and the HSMR. But it was also one of five in the country to record high mortality rates among patients which would normally survive – of 1,000 patients in this category, North Staffordshire recorded 1.39 deaths.

University Hospitals Birmingham NHS Foundation Trust was the only trust to record a higher rate, with 1.99 deaths per 1,000 patients in the low risk of death group.

There were 19 trusts which recorded higher than expected deaths across both the in-hospital measurement and the summary hospital-level indicator.

One of these was University Hospitals of Morecambe Bay NHS Foundation Trust, which had the highest in-hospital death rate.

The guide also reveals patients are more at risk of dying if they are admitted to hospital during the weekend. It names nine trusts where the in-hospital death rate was higher than expected at weekends only.

Reasons for the higher rate of deaths outside normal working hours included lack of available and consistent specialist services, lack of access to diagnostic services and varying degrees of staff experience.

A survey of staff ability outside of normal working hours found hospitals which have more senior staff on at weekends were likely to have a lower weekend mortality rate.

The rate at which hospitals perform surgeries has continued to have an impact on whether a patient will survive the surgery – those which performed the operation rarely had a higher death rate.

In particular, the guide found that hospitals which rarely performed an operation following an abdominal aortic aneurysm – the weakening of a major blood vessel – had 70% higher death rates.

The guide’s analysis of patient safety says it is improving, but data is too unreliable to know for certain how hospitals are performing. It says the number of occasions where an object was left in a patient dropped, but it was likely this has been under-reported.

Meanwhile, there were nine trusts which failed to comply with alerts from the National Patient Safety Agency on potentially unsafe practices. Those trusts said the reasons for non-compliance included lack of staff training and budget restraints on commissioning new equipment, in particular, the correct IT systems.

The guide has also highlighted four trusts which have both lower than expected mortality rates and positive feedback on patient experience.

The guide’s four ‘trusts of the year’ are; Royal Devon and Exeter NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust and Sheffield teaching Hospitals NHS Foundation trust.

Dr Foster Hospital Guide