JRSM > Volume 99, Number 6 > Pp. 303-308

This Article Figures Only Full Text Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Related articles in JRSM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wright, J. Articles by Warren, E. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?

Learning from death: a hospital mortality reduction programme

John Wright¹ Bob Dugdale² Ian Hammond³ Brian Jarman⁴ Maria Neary⁵ Duncan Newton⁶ Chris Patterson⁷ Lynne Russon⁸ Philip Stanley⁹ Rose Stephens¹⁰   Erica Warren¹¹

¹ Clinical Director, Clinical & Scientific Support Services, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
² Director of Risk Management, Clinical & Scientific Support Services, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
³ Operations Director, Clinical & Scientific Support Services, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
⁴ Emeritus Professor, Imperial College Faculty of Medicine, Dr Foster Intelligence Unit, London W2 5RT
⁵ Acting Operations Director Education, Training & Practice Development, Bradford Teaching Hospitals NHS Trust, Bradford BD5 0NA
⁶ Medical Director, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
⁷ Consultant—Care of the Elderly, Bradford Teaching Hospitals NHS Trust, Bradford BD5 0NA
⁸ Consultant in Palliative Care, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
⁹ Director of Infection Prevention and Control, Consultant in Infectious Diseases, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
¹⁰ Director of Hospital Services/Chief Nurse, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
¹¹ Clinical Quality Manager, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ

Correspondence to: E-mail: John.Wright{at}bradfordhospitals.nhs.uk

Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care.

Setting: A large acute hospital in an urban district in the North of England.

Design: Before and after evaluation of a hospital mortality reduction programme.

Strategies for change: Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control.

Effects: Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005.

Lessons learnt: Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related articles in JRSM:

Too little quality; too many doctors

Kamran Abbasi
JRSM 2006 99: 271. [Full Text]  

Learning from death: a hospital mortality reduction programme

John Wright, Bob Dugdale, Ian Hammond, Brian Jarman, Maria Neary, Duncan Newton, Chris Patterson, Lynne Russon, Philip Stanley, Rose Stephens, and Erica Warren
JRSM 2006 99: 303-308. [Abstract] [Full Text]  

This article has been cited by other articles:

				K. G. Shojania MD and A. J. Forster MD MSc Hospital mortality: when failure is not a good measure of success Can. Med. Assoc. J., July 15, 2008; 179(2): 153 - 157. [Full Text] [PDF]

				B. Crump Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? Yes BMJ, June 7, 2008; 336(7656): 1276 - 1276. [Full Text] [PDF]