Patient deaths at three London hospitals have been cut by almost 15 percent after introducing treatment checklists (known as care bundles), finds a study published on www.bmj.com. The researchers say their methods could be used to reduce mortality in many other hospitals.
The North West London Hospitals NHS Trust serves a population of about 500,000 at three sites: Northwick Park Hospital, Central Middlesex Hospital and St Mark's Hospital. In 2005 and 2006 the trust was subject to a series of adverse media stories which impacted staff morale and patients' perceptions of care. So a group of senior clinicians set out to reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care at the trust.
They developed eight care bundles for 13 diagnostic areas. These included treatments for stroke, heart failure and chronic obstructive pulmonary disease (COPD). Care bundles are a collection of treatment checklists based on clinical guidelines that, when combined, improve the effectiveness and safety of patient care.
Adjusted hospital mortality for the year the care bundles were introduced was then compared with the previous year using the hospital standardized mortality ratio (HSMR). It focuses on a group of diagnoses that account for 80 percent of all hospital deaths nationally and provides a tool for analyzing hospital outcomes over time.
The results show that the overall HSMR fell from 89.6 in 2006 to 71.1 in 2008, becoming the lowest among acute trusts in England. This translates to 174 fewer deaths occurred in the trust in the targeted diagnoses, and 255 fewer deaths over all.