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J R Soc Med 2006;99:303-308
doi:10.1258/jrsm.99.6.303
© 2006 Royal Society of Medicine

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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


Figure 1
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  		Figure 1. Hospital standardized mortality ratios (HSMRS)—(a) annually and (b) quarterly—for Bradford Teaching Hospitals Trust for period 1996 to 2005. Hospital mortality programme started in August 2002. CI, confidence interval

 

Figure 2
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  		Figure 2. CUSUM (cumulative sum) chart of hospital mortality. HSMR, hospital standardized mortality ratios. The rising slope demonstrates the periods when mortality was lower than expected (see p. 303 for more detailed explanation)

 

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