Dr Foster, the UK’s leading health information company, has today launched the 2011 Hospital Guide, the 10th edition of the guide, revealing for the first time levels of medical staffing in hospital at nights and weekends.
The Hospital Guide shows that patients are less likely to get treated promptly and more likely to die if they are admitted to hospital at the weekend. The chances of survival are better in hospitals that have more senior doctors on site. But some hospitals with A&E departments have few senior doctors in hospital at weekends or overnight. The guide identifies trusts with low levels of staffing and high mortality.
The Hospital Guide calls for re-organisation of services to ensure safe care 24/7. Examples of innovation from Poole, London, and Northumbria show this can be done to ensure access to high quality services at any time of day or night. Local A&E departments need to identify the services they can provide safely and link with others to provide the services they can’t.
The Hospital Guide, published in full at www.drfosterhealth.co.uk, provides a comprehensive assessment of standards and services at hospitals in England. It includes assessment of hospitals on four key measures of mortality. Chelsea and Westminster Hospital NHS Foundation Trust stands out as the only hospital with low rates on every measure. At the other extreme, Hull and East Yorkshire Hospitals NHS Trust is notable for consistently high rates. 19 trusts are high across two of the measures (HSMR and SHMI). The four measures are:
- Hospital Standardised Mortality Ratio (HSMR) – a measure of in-hospital deaths
- Summary Hospital-level Mortality Indicator (SHMI) – a measure of mortality both in-hospital and for deaths outside of hospital within 30 days
- Deaths after Surgery – surgical patients who have died from a possible complication
- Deaths in low-risk conditions – deaths from conditions where patients would normally survive.
Roger Taylor, Director of Research and co-founder of Dr Foster said: “A safe NHS is an NHS that provides care 24/7. This year’s guide shows we are some way from that target with significantly reduced services at weekends and nights. It is concerning that many of the issues raised in the first Hospital Guide remain problems ten years later: hospitals performing low volumes of surgery where high levels are needed to ensure good outcomes, and hospitals failing to meet the best standards of care despite many years of evidence of the impact this has on patients.
“However, fewer people died in 2009 than in any year since the mid 1950s – despite the population being larger and older. A large part of that success is down to improvements in care with in-hospital mortality rates falling steadily over the last 10 years since we first published the Hospital Guide.”
The Hospital Guide identifies 31 trusts that have an above expected rate for not treating hip fracture patients within the recommended two days of admission. Waiting time for surgery is a crucial factor, with longer wait times associated with higher death rates.
Patients treated in hospitals that perform certain operations rarely are more likely to die. Evidence of this has been available in many areas of surgery for more than a decade but the problem persists. The Hospital Guide found that death rates are 70 per cent higher following Abdominal Aortic Aneurysm (AAA) operations in low volume hospitals. The Hospital Guide names the 39 trusts performing low volumes of AAA surgery and suggests that they consider either increasing their volumes or ceasing to carry out these operations.
Some aspects of patient safety are improving but harm to patients still happens far too often. Unfortunately, we still do not record what happens to patients with sufficient accuracy to properly gauge how best to tackle the problem. Improvements to the data are the first essential step to addressing the problem. 9 trusts are named as not being compliant with National Patient Safety Agency (NPSA) alerts. The NHS reported to us that: 57 cases of surgery were performed on the wrong part of the body and there were 125 incidents of a foreign object left inside a patient after surgery.
Excellence in the NHS:
The Hospital Guide outlines many areas of excellence in the NHS. Poole Hospital NHS Foundation Trust, Northumbria Healthcare NHS Foundation Trust and Homerton University Hospital NHS Foundation Trust, for example, have shown innovative ways of refocusing their resources to meet the challenges of providing 24/7 care.
The Hospital Guide outlines the dramatic improvements in both mortality rates and reduced length of stay from the London Stroke Network which reduced the number of centres dealing with stroke from 31 to 8. It has the lowest mortality rate in England.
It is estimated that it takes 15 years from the discovery of a new treatment to its widespread adoption by doctors. The faster it can happen the better. The guide notes one particular success story, the introduction of PCI (Percutaneous Coronary Intervention), a new way to treat heart attacks. The death rate for heart attacks in England has declined by 2.5 per cent since 2006.
The Trust of the Year awards recognise excellence in the NHS. It is important to identify hospitals where the evidence points to outstanding achievement, both in outcomes and in how patients’ rate their experience of care. To be named Dr Foster Trust of the Year a trust has to perform highly on two important measures of hospital quality: mortality and patient experience. There is one winner for each of the new NHS regions.
The Dr Foster Trusts of the Year are:
(South) Royal Devon and Exeter NHS Foundation Trust
(London) University College London Hospitals NHS Foundation Trust
(Midlands) Cambridge University Hospitals NHS Foundation Trust
(North) Sheffield Teaching Hospitals NHS Foundation Trust
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