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Mortality data ‘not for public assurance’

24 Nov 2015

Mater Hospital, Dublin

Hospital mortality data must be used for quality improvement purposes and not to provide quality assurance, the RCSI’s annual Millin Meeting has heard.

Prof Conor O’Keane, Clinical Director, Quality and Safety at the Mater Hospital, said the Mater had been working on communicating more with the board and all staff about mortality and the complexity of mortality data, emphasising quality improvement.

Prof O’Keane said Standard Mortality Rates (SMRs) were not straightforward and it was often difficult to make comparisons with other jurisdictions depending on how the data were presented. “We need to make sure we are explaining mortality to our non-executive directors. If we get it right with them there is a reasonable chance we will get it right with the public as well,” he said.

2013 data showed the Mater had mortality rates that were average or better than average across a range of diseases. Some 289 deaths were recorded for all diagnoses, yet Prof O’Keane said he knew there were more than 700 deaths a year at the Mater. The gap arose where patients died in the Emergency Department, were dead/close to death on arrival or receiving palliative care.

Prof Simon Jones (PhD), Director and Chief Data Scientist at MedeAnalytics, said the British public had loved the star ratings introduced by the NHS in 2001 and scrapped in 2004. He said it was impossible to summarise the complexity of a hospital in a single number or star rating.

Dr Philip Crowley
, National Director, Quality Improvement Division, HSE, said he had worked in the NHS when the star system was in place and the “top starred hospital was the hospital you wouldn’t bring your dog to”.

The challenge with public reporting of data and targets was that it could have unintended consequences, e.g. consultant comparisons could lead to cherry-picking of patients with doctors not wanting to take on the “90-year-old with multiple co-morbidities”, Dr Crowley said.

The health service was under a lot of pressure to produce data on mortality, he said, and did not want to appear secretive. “I think the important thing is to present data intelligently after adequate checks and discussion.”

The publication of data was constantly being hindered by the desire to only publish when it was perfect, he added.

By Niamh Mullen


Click here to view the full article which appeared in Irish Medical Times