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Elizabeth Robb, director of nursing and a visiting professor at North West London Hospitals NHS Trust, and her colleagues, sought to better understand how to reduce hospital inpatient mortality and thereby increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. Their study appears in the April 1, 2010 issue of the British Medical Journal.
Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardized mortality ratio (HSMR) diagnoses covering 80 percent of hospital deaths. The study was conducted in an acute hospital trust in northwest London. The strategies for change included use of clinical guidelines in care bundles in eight targeted clinical areas. The key measure for improvement was a change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardized mortality ratio (HSMR) during the intervention year compared with the preceding year.
According to the researchers, the standardized mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-2007 to 71.1 in 2007-2008 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-2008 for the HSMR diagnoses than if the 2006-2007 HSMR had been applicable. From 2006-2007 to 2007-2008 there was a 5.7 percent increase in admissions, 7.9 percent increase in expected deaths, and 14.5 percent decrease in actual deaths.
The researchers conclude that implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.
Reference: Robb E. Using care bundles to reduce in-hospital mortality: quantitative survey. BMJ 2010;340:c1234. April 1, 2010.