TRUST’S “LEGAL THREAT” OVER DEATH RATES

30-11-2009

Birmingham University Hospital Trust – which runs the QE and Selly Oak – is warning of legal action over claims that its death rate is higher than expected. They have answered claims that 11 "foreign bodies" were left in patients bodies after operations.

The morale-sapping claims against the hospital were made by Dr Foster Intelligence, a research consultancy which works in partnership with the NHS.

UHB’s Medical Director Dr Dave Rosser argues that the research methodology is “fundamentally flawed”.

In a detailed statement published here in full, Dr Rosser said: “We believe there is a risk that figures like this could cause unnecessary confusion and panic amongst patients and is a distraction to concentrating on providing the best in care for our patients.

“We are currently taking advice from our lawyers about redress. And I would like to reassure patients that our hospitals are extremely safe places to be treated.
“UHB does not have a significantly higher than expected rate of death in low-mortality (flu, hernia etc) conditions. Our mortality rates have decreased from 7.1% (2007-08) to 6.6% (2008-09).

“We, of course, take any death of a patient in our hospitals very seriously and have a very robust and sophisticated system in place for monitoring them. Every member of the executive team gets an email every day telling them who has died, where and with details. Action is then taken immediately if appropriate. We do a very in-depth analysis of each death.”

Dr Rosser continued: “As NHS acute trust mortality is decreasing, Dr Foster have decided to rebase the “expected” death rate for this year’s Hospital Guide, which we understand has increased the average HSMR by between 7% and 10%. This has the effect of turning a good news story for the NHS into another scare story.”

“When we challenged Dr Foster about their methodology they declined to answer our detailed questions unless we were prepared to pay them to look more at the figures in greater depth.

“When we also refuted their methodology around the death in low-mortality conditions, they accepted our arguments and said they would be removing the measure. It appears that since we challenged Dr Foster in correspondence they have changed their minds.

“Patients will potentially think twice before wishing to be treated at a hospital with a supposed high rate of unexpected deaths.

Dr Rosser added: “Dr Foster’s methodology is based on a system designed for risk-adjusting for cancer and HIV patients, that is over 20 years old and is now being applied to patients outside these areas.

“Their analysis takes no account of significant, potentially fatal co-existing conditions, for example a patient who has a head injury and renal failure. It also does not take into account all procedures that the patients have had. For example, if a patient dies of a head injury it will be classed as ‘unexpected’, whether a hairline fracture not requiring any surgery, where a patient is very unlikely to die, or a massive head injury which requires complex surgery to open the skull, where the patient is more likely to die.”

“There is a danger that figures like this could create an incentive for doctors delivering complex care to very sick patients to think twice before doing some never-tried-before surgery in the hope of saving the life of a patient who may otherwise die, because they may be concerned that it will affect the Trust’s mortality rates. For staff at UHB the only consideration is doing what was in the best interests of the patient.”

“I think that we are in danger of moving into a situation where this indicator becomes more than an intellectual irritation and creates a serious problem for many Trusts and even the NHS as a whole. It is not in the public interest to be misled.”

UHB were also cited as having had six or more recorded incidents of foreign objects being left in patients following surgical procedures.

Dr Rosser explained: “This is a clear example of the danger of high level statistics being analysed by people with limited clinical knowledge of complex modern healthcare. Dr Foster makes a blanket statement that all such incidents are unacceptable. This is not the case. Out of the 11 incidents we reported, eight were conscious decisions not to attempt removal of the foreign body at the time, as to do so risked more harm to the patient than to not do so.

"For example, if a patient is in very poor condition, the surgeon may decide to close up the patient leaving a swab in, allow the patient to stabilise and remove the swab, say, 72 hours later, when the removal will present a much lower risk of the patient dying."

”In accordance with Trust policy all 11 incidents were reported and thoroughly investigated. Of the 11, three were unacceptable and immediate action was taken to prevent a recurrence.”

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