Care checklists cut deaths by 15%

Northwick Park hospital is one of three hosipitals which are using care checklists
12 April 2012

Treatment "checklists" have led to a 15% cut in patient deaths in three hospitals, research shows.

The aim of the lists is to cut down the number of deaths that could have been avoided and to improve patient care.

Each printed list - also known as a care bundle - includes details of best-practice treatment, such as when to administer antibiotics, the types of blood samples needed or the optimum level of oxygen saturation in the blood.

Some 7% of hospital admissions result in something going wrong (an adverse event), of which about 8% cause death. About half of adverse events are avoidable, research has shown.

In the latest study, the North West London Hospitals NHS Trust implemented eight care bundles known to help reduce risks for patients. The bundles covered 13 diagnostic areas with the highest number of deaths at the trust in 2006/07, including stroke, heart failure and chronic obstructive pulmonary disease (COPD).

The trust serves about 500,000 people at three hospital sites: Northwick Park Hospital, Central Middlesex Hospital and St Mark's Hospital. Researchers looked at the effect of the bundles on the hospital's standardised mortality ratio (HSMR).

An HSMR of 100 equates the same risk of death as the English national average, while 120 equates to 20% above the national risk and 80 to 20% below. After the care bundles were introduced, the HSMR of the trust fell from 89.6 in 2006/07 to 71.1 in 2007/08 - the lowest among acute trusts in England.

Overall, 255 fewer deaths occurred (174 of these in the targeted diagnoses) than if the 2006/07 death rates applied. The researchers said their methods could be used to reduce death rates in many other hospitals.

Writing in the British Medical Journal (BMJ), they said: "Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate."

A spokeswoman for the Department of Health said: "A high HSMR is a trigger to ask hard questions. Good hospitals monitor their HSMRs actively and seek to understand where performance may be falling short and action should not stop until the clinical leaders and the Board at the hospital are satisfied that the issues have been effectively dealt with."

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