Data quality not to blame for poor NHS performance

The UK Healthcare Commission's recent report detailing the failings in patient care at the Mid-Staffordshire Hospital Trust has criticised the trust for blaming poor coding and data rather than investigating the quality of care.

The Dr Foster Unit at Imperial College had identified that mortality ratios at the Mid Staffordshire NHS Trust were higher than expected and flagged a warning with the Healthcare Commission in July 2007 and again a month later.

The Healthcare Commission also noticed potential problems on its own data system and launched a full investigation.

Media coverage has highlighted how the early warnings provided by the Dr Foster Unit at Imperial College and the 2007 Dr Foster Hospital Guide were not acted upon quickly enough.

The West Midlands Strategic Health Authority has also come under fire for responding to these mortality alerts not by investigating potential patient care issues, but by commissioning a report into data from public health academics at the University of Birmingham.

Background

A Dr Foster analysis of the Mid-Staffordshire Hospital Trust showed that it had the fourth highest hospital standardised mortality ratio (HSMR) in England for the three-year period 2003 to 2006.

The Trust purchased Dr Foster's Real-Time Monitoring (RTM) system in early 2006, and used this for its internal surveillance of clinical outcomes.

The Trust then gave Dr Foster information generated using RTM for non-elective admissions for the financial year 2007/08, which showed that the trust had a significantly high mortality ratio in 10 ‘patient groups', and a significantly lower than expected mortality ratio outcomes in four groups.

The Healthcare Commission report stated that the Trust only began to monitor clinical outcomes after the publication of the high rate by Dr Foster in 2007.

The Healthcare Commission was provided with output from the Mid-Staffordshire Foundation Trust's RTM system for non-elective (emergency) admissions for 2007 to 2008, which helped instigate the current investigation and reveal the failings at the hospital. They found the likelihood of this many alerts within a single trust being false alarms to be very small.

Tim Kelsey, Chair of the Executive Board, Dr Foster Intelligence stated, "The NHS is now one of the most closely monitored health economies in the world and the alert that triggered the Mid Staffordshire investigation is evidence that this new system is working and that the NHS is beginning to use information and data effectively.”

The charity MRSA Action UK said it had called on the Department of Health to make better use of data and highlighted that Dr Foster's Hospital Guide revealed that Stafford General Hospital was not the only hospital with poor outcomes for some procedures.

Derek Butler, the chairman of MRSA Action UK, stated: "The [Dr Foster] data which is freely available and in the public domain should be used as a management tool, not only by the Hospital Trust Boards and managers, but by the regulators.”

Dr Foster Real-time Monitoring tool

The use of statistical tools to compare health outcomes across different hospitals and different clinical conditions is a relatively new phenomenon dating back to the establishment of the Dr Foster Unit at Imperial College in 2000 and its commercial arm Dr Foster in 2001.

The RTM system allows trusts to compare their clinical outcomes against all other acute trusts in England and against a local peer group, as well as monitor outcomes for specific consultant teams and by medical specialty.

If a significant change in a clinical outcome is detected, the RTM tool produces an automated alert.

Around 70 per cent of acute trusts have purchased Dr Foster's RTM system.

You can find out more about Dr Foster's RTM system on the Dr Foster corporate website.

Want to know how your local hospital compares? Visit Dr Foster Health's Hospital Guide.