Dr Heather Wood generously acknowledges (‘Hospital care concerns’, page 37, County Press 30th December 2011) that there may be more information available to reassure the public than that published in direct response to enquiries about hospital mortality ratios. This is indeed the case and we are grateful for the opportunity to provide this.
Mortality ratios are difficult to interpret as an indicator of quality of care in a hospital and should never be taken in isolation - for example we would not simply consider lower ratios satisfactory evidence that we provide high quality care. As Dr Wood implies, it is how staff, especially senior managers, react to these which is at least, if not more, important. There has been no complacency whatsoever and strenuous efforts have been made to understand and continuously monitor the quality of care provided at St Mary’s Hospital on the basis of patient level information of varying sorts.
Dr Foster both highlighted the issue around death rates and confirmed that some of the problem is down to coding. However in some areas we needed to improve care. We have investigated and taken action when reports have suggested death rates at St. Mary’s are higher than would be expected. The Francis Review of Mid Staffordshire NHS Trust was a salutary lesson for all hospitals and we are taking forward a number of actions based on the findings, to do our best to ensure these are not repeated at St Marys.
We have reviewed the care we provide in a number of areas to ensure it is in line with best clinical practice. Specifically we :
- have undertaken a detailed review of patients dying within 4 days of admission;
- have reviewed all the deaths associated with bladder and kidney infections, and deaths in patients admitted with hip fractures over the last year;
- have appointed two new consultants to allow rapid senior review of emergency medical patients in the first 48 hours after admission;
- have extended the innovative intensive care outreach service which increases the availability of a team of highly skilled nurses to look after seriously ill patients throughout the hospital.
- are introducing new policies and practice for the management of patients with infections (e.g. sepsis and hospital acquired pneumonia).
We have made arrangements for an external agency to analyse our data on a monthly basis and report any issues that they discover. This will alert us to issues we need to investigate and provide assurance that the changes we have made are having an impact. We already know from our own monitoring that between April 2010 and December 2011 the level of cardiac arrests suffered by patients whilst in hospital has reduced from 6 to 2 per month, which shows that patients are being effectively identified and treated before their condition deteriorates.
We also have assurance from two other external reviews. In the last two years the Strategic Health Authority has reviewed deaths in emergency surgery and Imperial College London reviewed stroke patient deaths. Both of these organisations found just one case where they had a significant concern and we have taken appropriate actions to manage the issues arising in this case.
We agree that pressure sores are an indicator of nursing care – they are also extremely distressing for patients and we pay particular attention to reducing their occurrence. We know from our own monitoring for example that the percentage rate of newly acquired pressure ulceration Grades 3 to 4 in in-patients has fallen from 0.43% in April 2010 to 0.16% in November 2011. For grades 2 to 4 the reduction is from 2.21% to 1.96% over the same period.
Dr Wood and Islanders may find it reassuring that we were recently cited as an example of a Trust with a very low readmission rate, suggesting that we send patients home in better condition then the average NHS hospital. We consider this to be an excellent indicator of overall care and the effort we put in to getting it right for patients rather than just chasing targets. We have in the last year introduced the ‘Lets Show We Care’ initiative to our staff and details of the standards we expect from ourselves and our staff can be found at www.iow.nhs.uk/wecare.
Monitoring mortality ratios is just one of the ways in which we measure the clinical effectiveness and quality of our services and ensure the safety of patients. Since June 2009, as part of our transparent and open processes we have published mortality data as part of the Quality Report at our Public Board meetings. You can view our reports at www.iow.nhs.uk/performance.
Finally, we recognise that Dr Wood has a breadth of experience across the NHS which we would like to encourage her to share with us for the benefit of all Islanders and we are extending an invitation to her to meet with the senior management team at St. Mary’s.
Dr Mark Pugh Carol Alstrom
Medical Director Chief Nurse & Director of Infection Prevention & Control