Agenda item

[Dr Jonathan Odum, Medical Director, RWHT, to present report]

Dr Jonathan Odum, Medical Director, RWHT, presented a report on published hospital mortality statistics and analysis of the results for the panel. Dr Odum explained the method for calculating individual hospital mortality rates which is used to compare performance of hospitals in England.

Dr Odum explained that the calculation of standardised mortality rate is based on a complex formula, as detailed in the report. Dr Odum added that the reported results of increased mortality rates for RWHT do not show evidence of poor quality care or ‘avoidable’ deaths at the hospital.  However, the results are being analysed to identify deaths that may have been avoidable and any learning used to improve future practice.

Dr Odum explained that Wolverhampton traditionally had a Standardised Mortality Rate(SMR) of 100 –  however this figure has increased to 115 since the opening of the new emergency department which may explain why there have been more deaths than expected. The death rate figure is based the count of adults over the age of 18 years. The hospital has the lowest death rate in the West Midlands region.

The panel queried the impact of the opening of new emergency department on the increase in mortality rate. Dr Odum explained that a new triage and assessment procedure has been introduced which had been very successful in managing patient flows – the changes had led to a reduction of 2000-3000 admissions to hospital a year. 

Dr Odum explained that the Swan end of life care model had been introduced at the hospital which has resulted in fewer people being referred to the palliative care team and increased the hospital mortality rate. The Swan programme offers dedicated support to patients in the last days of life and to their families into bereavement and beyond.

Dr Odum reassured the panel again there was no evidence to suggest that the increase in mortality rates for RWHT was due to poor quality care, but work will continue to be done to review procedures to see what further changes are needed to improve the situation.

The panel thanked Dr Odum for his presentation.

The panel queried if the increase in the number of people who needed hospital admission after being assessed was a factor as they would be at higher risk of death. Dr Odum explained the patients are managed in a different way following the opening of the accident and emergency centre and also figures are affected by the fact that the hospital has a high percentage of people who die in hospital rather than being discharged to a hospice or home.

The panel discussed that given the reasons for the increase in death rates and the value in dedicating time and resources in trying to understand when there was no evidence to suggest that they were due to poor quality care.

David Loughton, RWHT, explained that changes in SMR and Summary Hospital-level Mortality Indicator(SHMI) referenced in the report act as ‘smoke alarm’ and that it was important that it should not be ignored. David added that it is important for the hospital to investigate if there are any common factors to explain changes in death rates by carefully anaylsing the data and whether any were avoidable.

Dr Odum explained that the hospital will also investigate death within 30 days of a patient being discharged to investigate the reason. Dr Odum explained the challenges facing the hospital in caring for patients who are elderly and frail.

The panel discussed the hospital policy of end of life care. Dr Helen Hibbs, WCCG, commented on the number of people with cancer diagnosis and the work being done with GPs to improve early diagnosis and appropriate referrals to hospital for treatment. Dr Hibbs added that the CCG is expecting to see improvements in the next year. David Watts commented on the introduction of ‘red bag’ which contains important information about the patient and their wishes for future care. David agreed to present an update report on progress of the scheme to the panel in March 2018.

Resolved:

The panel agreed to note the findings and agreed to monitor the performance of standardised mortality rates at RWHT against national standards and receive an update on progress at a future meeting.