Dr Foster Intelligence | Case studies

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Success stories

When the Dr Foster data was first published it was rather like having a major incident. We spent a lot of time setting up what I think is a first class clinical governance framework.

Mike Browne Medical Director

Using information to save lives

In 2000, Walsall Hospitals NHS Trust had 8734 admissions for the 80 diagnoses that lead to 80% of all hospital deaths. For these diagnoses, Walsall had 1080 deaths, compared with 830.7 that would be expected using England death rates by age, sex, admission method, multiple deprivation score, and diagnosis as standard, giving an HSMR of 130 (1080/830.7x100).

After a wide range of improvements in care were introduced, starting in 2001, the adjusted fall in observed minus expected deaths at Walsall was 295 by September 2004 for the diagnoses that lead to 80 per cent of all deaths.

[more info] Hospital standardised mortality ratios, Walsall Hospitals NHS Trust, 1996-2004. Treatment changes were implemented in 2001 with a dramatic improvement in their mortality ratios.

Solution

Walsall's medical director, Mike Browne, and his colleagues formed seven clinical governance groups to implement changes in clinical disease areas: heart, malignant, gastrointestinal, respiratory, renal, diabetes, other vascular groups, trauma and orthopaedics, anaesthetics, resuscitation, accident and emergency, critical care, outpatients, dietetics, children, and elderly care.

Similarly, changes were initiated at all levels in management areas: audit department, clinical risk, continuing professional development unit, bed management, information services and performance management, research and development, education, discharge liaison team, workforce development, integrated care pathway development, national confidential inquiries, NICE guidelines, NSF update reports, clinical governance structure, and the Primary Care Trust Evercare project.

Browne explains what happened: "When the Dr Foster data was first published it was rather like having a major incident. We spent a lot of time setting up what I think is a first class clinical governance framework. We focused on mortality and looked at all the outlying areas. We set up seven groups - each group was given outliers to look at and identify where things could be done as well as a senior director to give it clout. There was no simple way to change things - no single cause. It was one long slog across the board."

[more info] A new clinical governance framework was put in place 2001, which resulted in a sharp and sustained reduction in hospital standardised mortality ratios.

Outcome

Between 1996 and 2001, Walsall's mortality rate crossed the alarm threshold many time. This implies that the risk of death at Walsall often rose to at least twice the national average during that period.

After the improvements were introduced in 2001, the mortality rate crossed the alarm threshold only twice.

Tool

Real Time Monitoring