Dr Foster Intelligence

Safety

Problem: In 2004, the trust was investigated by the Healthcare Commission for poor management and lack of medical leadership due to a high mortality rate that they could not explain. They were subsequently put in special measures.
Solution: They put in place a new system, including Real Time Monitoring, for analysing clinical outcomes.
Outcome: Two years later, special measures were lifted, mortality has fallen from 98 in 2003 to 88 in 2006, and lengths of stay have dropped from 99 in 2003 to 82 in 2006.
Tool: Real Time Monitoring

Problem: High mortality rate for lower gastrointestinal surgery
Solution: Essex Rivers uses Real Time Monitoring to routinely monitor clinical outcomes and to highlight where potential issues may lie. As medical director, Dr Marion Woods assumes every red alert on the system to be a serious problem needing investigation. When she examined the data for lower gastrointestinal surgery, she discovered that the mortality ratio of 49 was significantly higher than the expected ratio of 32.9. The rates were normal for planned surgery but higher for emergency admissions.
Outcome: They created a new rota to ensure that an experienced surgeon was always available and the mortality rate lowered by 18%
Tool: Real Time Monitoring

Problem: In 2000, the trust had an HSMR of 130, the highest of all main acute hospitals in England
Solution: Walsall set up seven clinical groups to identify where improvements could be implemented and used Real Time Monitoring to monitor their mortality ratio over the next four years
Outcome: By September 2004, the hospital's mortality ratio had reduced from 130 to 92.8.
Tool: Real Time Monitoring

Problem: Disputed mortality rate for pneumonia
Solution: When it was claimed that the trust's mortality rate for pneumonia was above the national average, it carried out a full internal audit to investigate whether the claims were justified and verifiable. This resulted in changes being made to the patient pathway that included the set-up of a specialised acute lung unit.
Outcome: Reduced mortality by 14 per cent and increased scrutiny and accountability across clinical teams
Tool: Real Time Monitoring and Hospital Marketing Manager

Problem: An apparent increase in mortality for fractured neck of femur
Solution: The Royal Wolverhampton Hospitals NHS Trust was asked by its Strategic Health Authority to investigate a seeming increase in its mortality amongst patients undergoing hip fracture repairs in April 2005. This apparent rise had only just been picked up by the SHA which was looking at 12-month old data.
Outcome: The trust was able to immediately respond to the strategic health authority inquiry with up-to-date and accurate information proving that the incident was an anomaly and that high clinical standards are the norm.
Tool: Real Time Monitoring