New mortality indicator for NHS

The NHS is to introduce a new standardised method for measuring death rates from April 2011.

The review group set up to examine the Hospital Standarised Mortality Ratio in the wake of the scandal at Mid Staffordshire NHS Foundation Trust said today that the HSMR should be replaced.

The Steering Group for the National Review of the HSMR published plans for a Summary Hospital-Level Mortality Indicator that the Department of Health says will be subject to rigorous independent testing ahead of its introduction next year.

The SHMI will calculate the deaths of all admitted patients in all care settings except specialist hospitals. This will include deaths occurring up to 30 days after discharge.

The indicator is being dubbed as a ‘smoke alarm’ by the DH. It says the new indicator may ‘go off’ when there is no fire to put out; but because it may indicate a serious problem it should always be examined.  

However, the review group’s report stresses that mortality rates must not be used in isolation. It says the introduction of the new indicator should be accompanied by “companion indicators and other supporting information, to aid appropriate interpretation.”

A statement from the DH added: “While it can help to shine a light on potential areas for further analysis or investigation, it cannot be used as a standalone indication of quality or to rank hospitals in crude league tables.”

The report says there should also be advice on the publication, presentation and use of data to prevent confusion. And it suggests that a month’s ‘shadow run’ should take place to allow trusts to familiarise themselves with the SHMI.

Professor Sir Bruce Keogh, who commissioned the review on behalf of the National Quality Board, said: "We are the first country to make a systematic attempt to engage healthcare providers, academics, institutions of medicine and the commercial sector in developing a clear method for assessing expected hospital death rates.

“The methodology will be open to public and academic scrutiny and debate so that it improves and becomes more useful over time."

The report recommends that the SHMI should be published simultaneously by the NHS Information Centre and by NHS Choices, so that patients can access the information easily.

Ian Dalton, who chaired the review as chief executive of NHS North East and is now the director of provider development at the DH, said: “This is a huge achievement – we now have a wide-ranging consensus not only on the best way to measure mortality but also on how this measure should be used.

“A high SHMI on its own is not an indication of poor standards of care but it is a trigger to take action.

"Hospital boards across the country have a responsibility to pursue questions the SHMI might raise and quick action will help to ensure safe care for patients at all times.”

Link: Review group report and proposals