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SOUTH TEES HOSPITALS NHS FOUNDATION TRUST Agenda Item: 12 Trust Mortality Report for Board of Directors data to end of Q4 2014/15

Report prepared by Tony Roberts and Jo Raine, Clinical Effectiveness. 03/07/2015 of 24 M:\Clinical Governance\Clinical Effectiveness\CHKS\Mortality Reports for Board\FINAL Mortality Report Divisional Level Q4 14/15

Next Steps

Development of the specialist palliative care service is likely to be reflected in increased numbers of patients receiving a specialist palliative care code and the Trust should monitor the impact this has on HSMR.

The Trust is collecting data for the national CQUIN schemes for patients with sepsis and acute kidney injury. The Trust should use this data to assess the impact on mortality in these high risk patient groups.

Supports Trust Strategy Map in the following areas

quality & patient safety

business sustainability

operational excellence organisational capability

deliver integrated care improved cost

control improved patient flow improved

information

forefront of clinical innovation

increased productivity

improved innovation processes

continuous service improvement culture

specialised services development

increased revenue & market share

strong governance & risk management

workforce development

service quality and safety

enhanced services

strong partnerships & engagement

If a key risk(s) has been identified, please describe below

The Trust continues to be an outlier on HSMR.



Contents

1 Executive Summary .......................................................................................................... 5

2 Recommendations for improvement of mortality ........................................................... 5

3 Background to Report ...................................................................................................... 6

4 Methods ........................................................................................................................... 6

5 Report from the Mortality Group ..................................................................................... 6

Table 1: Lessons Learned: Mortality Reviews Q4 2014/15 ......................................................... 7

6 Mortality Measures: Summary Hospital Level Mortality Indicator (SHMI) and Hospital Standardised Mortality Ratio (HSMR) .............................................................................. 8

Table 2: SHMI, total discharges, observed and expected deaths, % aged 75+ and banding by Acute Trust for October 2013 – September 2014. ................................................... 8

Figure 1: SHMI with banding using 99% Control Limits and over‐dispersion adjustment ......... 9

Table 3: HSMR, total discharges, observed and expected deaths, HSMR with and without palliative care adjustment for January 2014 ‐ December 2014. ................................... 9

Figure 2: HSMR by Acute Trust for January 2014 ‐ December 2014......................................... 10

Figure 3: SHMI and Unadjusted Mortality Rate for South Tees. .............................................. 11

Figure 4: HSMR and Palliative Care Coding for South Tees. ..................................................... 11

Figure 5: Proportion of Deaths with Palliative Care Coding (South Tees, North Tees and County Durham & Darlington Trusts) ....................................................................................... 12

Figure 6: Spells with palliative care coding (specialist: Z515, general: Z518) South Tees Hospitals NHS FT April 2011 to May 2015 ................................................................................ 12

7 Mean‐Centred HSMR and SHMI ..................................................................................... 13

Figure 7: Mean Centred displays for SHMI and HSMR: South Tees. ......................................... 14

8 Unadjusted Mortality: Trust Overview ........................................................................... 15

Table 4: Crude Mortality: number of deaths, mortality rate and peer data to Centre level April 2014 – March 2015. ................................................................................................. 15

Figure 8: Crude Mortality Rate April 2005 – April 2015 including Rolling 12 month averages. .................................................................................................................................. 15

Figure 9: SHMI Defined Mortality Rates: Trust, North East Region and National July 2011 – January 2015. ............................................................................................................... 16

Figure 10: SPC Chart of Deaths April 2006 – May 2015. .......................................................... 16

Figure 11: Deaths per month per Division and Centre January 2011 – April 2015. .................. 17

Table 5: Deaths in South Tees Acute and Community Hospitals April 2014 – March 2015. ......................................................................................................................................... 17



Figure 12: Observed and Predicted all‐cause death registrations England & Wales. Excess mortality in 65+ year olds by week of death, England .................................................. 18

Table 6: Deaths in South Tees Acute and Community Hospitals by CCS Group and Age Group October 2014 – March 2015. ......................................................................................... 19

Figure 13: South Tees: Number of deaths per week to 26 May 2015. ..................................... 19

9 Intelligent Monitoring Report and Dr Foster Intelligence: Quarterly Mortality Data Release ........................................................................................................................... 19

Figure 14: CQC Intelligent Monitoring Report May 2015 ......................................................... 20

Figure 15: South Tees Dr Foster Quarterly Mortality Data Release July 2013 ‐ June 2014 ...... 20

Figure 16: All Trusts: Hospital Standardised Mortality Ratio July 2013 – June 2014 ............... 20

Figure 17: South Tees: Women & Children Centre: Trends on perinatal rates from 2000‐2014 .......................................................................................................................................... 21

Figure 18: SHMI for Colorectal Cancer ..................................................................................... 22

Table 7: SHMI for Colorectal Cancer ......................................................................................... 22

10 Mortality in A&E Department – Dead on Arrival or Died in Department ...................... 23

Figure 19: Dead on Arrival or Died in Department April 2005 to date. .................................... 23

Table 8: Initial Diagnosis on arrival at A&E: Dead on Arrival / Died in Department. ............... 23

11 Conclusion ...................................................................................................................... 24

12 Recommendations for improvement of mortality ......................................................... 24

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