Hospitals and avoidable mortality rates…the saga continues

Regular readers of this blog will now I’ve had a bit of a bee in my bonnet about government plans to rank hospitals on avoidable mortality based on retrospective case record review. I won’t go into the arguments in detail again (if you want you can read them in the original blog here, or the paper that was written based on that blog here) but essentially it comes down to the fact that trying to rank hospitals on the inevitably small number of deaths that will be reviewed per hospitals means that the resulting ranks are influenced far more by chance than by any avoidable mortality.

A couple of days ago it was brought to my attention that the tender (which you can find here) has gone out for somebody to put these plans into action. £1.7 million is available for someone to perform this ultimately pointless task (although I acknowledge in my previous discussions there are things to be learnt from case note reviews and they can be useful, just not for ranking hospitals). The tender makes specific reference to the Preventable Incidents, Survival and Mortality Study (PRISM) study and is it clearly good to see research being put into practice. However, when the lead study has recently stated in an article in the BMJ that avoidable mortality measured in this way is not “a helpful or informative indicator of the quality of a trust”, one has to worry.

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