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HSE lacks key hospital death data
Nearly 12,000 patients died in Irish hospitals last year, according to information obtained by irishhealth.com
However, the HSE has admitted that it does not have access to any statistics which would show whether the number of deaths occurring in any particular hospital are above or below the norm. Nor does it have access to other key comparative detailed clinical data from hospitals.
This data, which is of major importance to maintaining patient safety, does not appear to exist in any way to allow the HSE to monitor it or to make it available to the public. This means that patients currently have no way of comparing potential risks of treatment in different hospitals.
The independent health safety body HIQA says this type of information should be readily available to the HSE and for the public to view.
Information obtained under FOI shows that 11,697 people died in Irish acute hospitals in 2008, compared to 11,967 the previous year.
This compares to just over 9,400 patient deaths in hospitals recorded in 2002, the last year for which mortality figures were previously released to irishhealth.com
Since then, hospitals would have recorded a considerable increase in activity levels. There were 892,634 discharges from acute hospitals in 2002 compared to 1,317,626 in 2007.
However, the crude mortality numbers do not show the whole picture.
The HSE does not have current “hospital standardised mortality rates”. These are figures that show how much one hospital’s death rates might differ from the norm after adjustments are made to reflect the risk and complexity of a hospital’s caseload.
For example, a hospital treating a large number of cancer cases or performing a large number of complex operations would be likely to have a have a higher mortality figure than another hospital doing less of this type of work.
The current lack of available data, however, means that the HSE does not have any “alarm bell’ system where it could potentially see if a particular hospital had death rates that were above standardised norms for a hospital of a similar size and with a similar caseload and workload.
It means that at present, the HSE cannot make any inquiries or take any action if it believes a particular hospital’s death rate in a particular specialty might be a cause for concern.
A spokesperson confirmed that the HSE does not have any data on hospital-standardised mortality ratios.
General statistics on admission numbers and disease rates on a national and regional basis are collated and published by the ESRI, which runs the the Hospital Inpatient Inquiry Scheme (HIPE).
However, the ESRI told irishhealth.com that it does not have standardised mortality rate data for individual hospitals, which could be made available to the HSE.
Nor does the HSE have oversight of comparative statistics on diseases treated, procedures, or clinical incident/error rates for each hospital in the country. These figures are not published on an individual hospital basis by the ESRI.
This means the HSE would not know, for example, whether the number of operations performed in a particular specialty in a particular hospital was over or above the norm and therefore might be a cause for concern.
A HSE spokesman said that while it does not currently have access to standardised mortality or other hospital clinical data on an individual hospital basis at present, it is its intention to collate these statistics and make them available to the public.
However, the HSE could not put a timescale on when this would take place.
He said the HSE recognised that from a service quality perspective, there was a need to collate this data and make it available to the public.
The spokesman added that work on this was currently being undertaken by the HSE's recently-established Quaity and Clinical Care Directorate.
According to the HSE, hospitals on an individual basis would have information on mortality and other clinical data, but not in a standardised or systematic format.
A spokesman for HIQA said they would feel mortality and other standardised patient data on all individual hospitals should be made available and should be provided to the public. HIQA stressed, however, that any mortality data provided should take account of a particular hospital's workload and casemix.
The HIQA spokesman said this type of data may in time become available when a hospital licensing system is put in place.
A spokesman for Patient Focus said its view would be that the more information of this type that is made available to the public the better.
The figures provided to irishhealth.com show that Beaumont Hospital in Dublin had the highest number of deaths last year, at 789, followed by St James’s at 778 and the Mater at 668.
St Vincent’s in Dublin recorded 649 deaths among patients last year, while 524 died at Cork University Hospital.
The National Health Service in the UK is planning to publish hospital standardised death rates on its website.
The Department of Health in the UK says it intends to give patients access to information about mortality rates to help compare the risks of treatment in different hospitals.
The UK Department pledged to make these statistics available to the public after a scandal over serious failures in emergency treatment at a hospital trust in the English midlands. These failures went undetected for some time, an investigation found.
The following is a list of some of the major Irish hospitals and their death numbers in 2008 and 2007:
2007 2008
Mater 698 668
St Vincent’s 624 649
St James’s 860 778
Connolly 313 335
Beaumont 827 789
Talaght 423 447
Waterford Reg. 465 457
Cork University 527 524
Reg, Limerick 442 452
UH Galway 515 528
Letterkenny 297 267
Lourdes, Drogheda 269 245
OLCH Crumlin 70 65
Temple St. 27 19
Holles St 24 22
Coombe 6 26
Rotunda 24 16
[Posted: Fri 20/11/2009]
