Learning from death: a hospital mortality reduction programme

J R Soc Med. 2006 Jun;99(6):303-8. doi: 10.1177/014107680609900617.


Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care.

Setting: A large acute hospital in an urban district in the North of England.

Design: Before and after evaluation of a hospital mortality reduction programme.

Strategies for change: Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control.

Effects: Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005.

Lessons learnt: Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality.

MeSH terms

  • England
  • Hospital Mortality*
  • Hospitals, Public / standards*
  • Humans
  • Medical Audit
  • Urban Health