Title: Evaluation of a National Surveillance System for mortality alerts
Funder: Department of Health (England)

Abstract: The dr Foster Unit at Imperial has generated monthly mortality alerts since 2007 (based on statistical process control). They are derived from routinely collected hospital administrative data on 122 diagnoses/procedures for English acute non-specialist NHS hospital trusts. Mortality alerts are sent to trusts without charge and copied to the Care Quality Commission if the mortality rate exceeds a high threshold. This joint mortality surveillance system was pivotal in alerting the then Healthcare Commission to problems at Mid Staffordshire NHS Foundation Trust. Our proposal in collaboration with the Professor Aneez Esmail from the University of Manchester and supported by CQC aims to improve understanding of these alerts and to evaluate their impact as an intervention to reduce avoidable mortality within English trusts.Research questions • Do mortality indices reflect anything about avoidable deaths and wider quality of care?• How do trusts respond to mortality alerts? • How can current responses to mortality alerts be improved? Objectives1. Describe the findings and impact of a national mortality surveillance system as a feedback mechanism for quality improvement.2. Determine the relationship of alerts to other potential indicators of quality.3. Determine the temporal patterns of alerts and whether they are associated with subsequent changes in mortality rates at trusts.4. Describe trusts’ responses to receiving mortality alerts and the impact on safety/quality improvements including organisational and staff behaviour.5. Determine whether there are differences in the delivery of care at frequently alerting trusts compared with trusts that alert rarely for two conditions commonly generating mortality alerts - acute myocardial infarction and septicaemia.6. Determine at trusts where mortality decreased after alerts whether they were more likely to apply common safety/quality interventions compared with trusts that repeatedly alert.AnalysisWorkstream 1 will describe trends in mortality alerts and also examine the relationships between these alerts and outcomes following investigation as reported to CQC and other measures of quality of care through statistical analyses of hospital administrative data.Workstream 2 will include two phases of investigation. Phase A will employ comparative institutional case studies for 12 sample trusts alerting for either acute myocardial infarction or septicaemia. This will inform the development of a structured evaluative telephone survey to categorise and quantify organisational behavioural and contextual aspects of the response to alerts in Phase B. and will permit the analysis of whether these are related to changes in mortality after the alerts.Project outputs will include research reports papers in peer-reviewed academic journals conference presentations seminars and guidelines for trusts on how to respond to mortality alerts (a template for action) and recommend how to improve the surveillance system.Benefits and impact of research• Inform service provision policies for the conditions/patient groups investigated• Support national quality improvement initiatives• Improve the joint national surveillance system and public trust in it• Increase understanding of administrative data use (suitability and usability) for mortality monitoring• Learn from trusts that effectively respond to mortality alerts (reduced or consistently low mortality rates


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE