Objective: To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses.
Data sources: Routine English hospital admissions data.
Study design: Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing each hospital with the national average and its peers for in-hospital mortality, length of stay, and emergency readmission within 28 days.
Data collection: Data were derived from the Department of Health administrative hospital admissions database, with monthly uploads from the clearing service.
Principal findings: The tool is currently being used by nearly 100 hospitals and also a number of primary care trusts responsible for purchasing hospital care. It monitors around 80 percent of admissions and in-hospital deaths. Case-mix adjustment gives values for the area under the receiver operating characteristic curve between 0.60 and 0.86 for mortality, but the values were poorer for readmission.
Conclusions: CUSUMs are a promising management tool for managers and clinicians for driving improvement in hospital performance for a range of outcomes, and interactive presentation via a web-based front end has been well received by users. Our methods act as a focus for intelligently directed clinical audit with the real potential to improve outcomes, but wider availability and prospective monitoring are required to fully assess the method's utility.