Hospital mortality under surgical care

Area of Science:

• Healthcare Performance Measurement
• Medical Statistics
• Surgical Outcomes Analysis

Background:

• The hospital standardised mortality ratio (HSMR) is a key performance indicator for NHS hospitals in England.
• Recent criticisms highlight significant variations in HSMR, questioning its validity as a sole performance measure.
• This study examines the accuracy of HSMR data for a consultant general surgeon.

Purpose of the Study:

• To review mortality data for a consultant general surgeon over three years.
• To evaluate the accuracy of diagnosis and covariate coding used in HSMR calculations.
• To assess the reliability of clinician-specific mortality data for performance evaluation.

Main Methods:

• Utilized the Dr Foster Intelligence database to extract HSMR benchmark data for inpatient mortality.
• Focused on data for a specific consultant general surgeon from April 2006 to March 2009.
• Compared extracted HSMR data against original hospital patient records.

Main Results:

• Identified 30 patients; 12 (40%) were incorrectly attributed to the surgeon.
• Of the 18 correctly attributed patients, co-morbidity data (Charlson index) was recorded for only 27% (operative) and 43% (non-operative) despite 94% having significant co-morbidities.
• Indicates substantial inaccuracies in attributing consultant responsibility and recording case-mix adjustment data.

Conclusions:

• Clinician-specific mortality data, as used in HSMR, can be crude and inaccurate.
• The potential for misrepresentation is high, especially when avoidable adverse events constitute a small percentage of deaths.
• Relying on such data for performance assessment may be irresponsible and misleading.