Dr Foster Hospital Guide 2009
The Dr Foster Hospital Guide 2009 was released last week. The release was notable because it followed the censure of the Basildon and Thurrock University Hospitals NHS Foundation Trust and the Colchester Hospital University NHS Foundation Trust by the regular Monitor. The Dr Foster report was released soon after Monitor intervened in those two hospitals and Dr Foster congratulated itself because their list placed Basildon and Thurrock at the bottom of their patient Safety league table. Unfortunately newspapers seem to have simply taken the headline figures from the Dr Foster report and extrapolated suggesting alarming figures of unexpected deaths at our hospitals. A detailed analysis of the report can be found on this page to allow readers to put their hospital's score into perspective.
The Dr Foster report mentions South Warwickshire General Hospitals Trust in three places:
- Percentage of suspected stroke patients given a CT scan within 24 hours:
- Hospital Standardised Mortality Ratio: 116
- Patient Safety league table: 17.81, band 2
As a governor of this hospital trust I think an explanation for these values is needed.
National guidelines say that hospitals must carry out a computerised tomography (CT) scan within 24 hours of a stroke, to see where exactly the stroke took place. This enables clinicians to determine whether the stroke was a clot or a bleed and hence determine the best treatment. Dr Foster lists the ten "worst" hospitals who scan less than 40% of suspected stroke patients. South Warwickshire score 36%, however, this value is from March 2008, more than 18 months out of date. The latest scores are available from the hospital in the Standards and Targets Report. This document shows that the actual value for the year to date is 79.1% (this is in the Patient Outcomes section on the KPIs - Internal sheet). Clearly the current value is more than twice the value quoted by Dr Foster. The Dr Foster value is out of date, and if the current values was used then South Warwickshire would not appear in the table.
South Warwickshire has a high value for HSMR. In response to this score the Trust says:
The Trust has not received any mortality alerts during the year from quality regulators which are the formal channels to flag any concerns. We therefore asked Dr Foster to help us to understand their model and to seek intelligence on areas where we can make improvements. This work has shown no significant issues and has led us to conclude that crude mortality is a more reliable measure.
It is frustrating that our HSMR is worse that last year despite mortality reducing however all other indicators are at odds with this and there are no clear defined reasons for the score.
The Trust points out in a separate document that for the last two years deaths in the hospital has decreased and that the high HSMR value may be due to the elderly nature of the local population.
The Patient Safety score is a statistical measure and the absolute value of 17.81 should only be used to rank the hospital compared to others in the league table. The score is based upon the values supplied by the Trust and these are posted on Dr Foster's website in the trust's quality account. There are 13 safety measures, and in all cases but two the Trust scores "in line with expected" scores. The two other scores are HSMR (all admissions) and HSMR (non-elective) where the Trust is marked as "below expected". Analysis of the table indicate that HSMR contributes significantly to the patient safety score and so it can be concluded that the ranking of the Trust is mainly due to higher than average HSMR values.
The Patient Safety league table ranks hospitals based on the 13 values in the Trust's quality account. This ranking is an inexact process involving statistical methods. The inexact nature can be seen when you compare the Dr Foster Patient Safety league table with the CHKS Ltd Top Hospital List 2009. Just nine of the top forty best hospitals in the Dr Foster league table are in the CHKS top hospitals list, whereas eleven of the lowest forty hospitals in the Dr Foster list are in the CHKS top forty list. This disagreement between the two lists of hospitals does not mean that one list is better than the other, but it does show that you should take league tables of good hospitals and bad hospitals with a fair amount of scepticism.
A detailed analysis of the report can be found on this page.