Abstract
BackgroundThe quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated.MethodsA retrospective study using the English Hospital Episode Statistics 2005–2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR).Results2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups.ConclusionsHospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.
Highlights
The quality of care delivered and clinical outcomes of care are of paramount importance
A rating system can only be useful if significant variations in outcome exist between hospitals, and can only be of value if the outcomes of different diagnoses are inter-related within individual hospitals [5]
The objectives of this study were to determine whether the risk-standardised clinical outcomes for emergency admissions varied significantly between providers, and whether outcomes were inter-related between different diagnoses at a hospital level
Summary
The quality of care delivered and clinical outcomes of care are of paramount importance. One common theme has been a failure to deliver safe and high quality care, with subsequent poor clinical outcomes. In response to such variations and failures, there have been suggestions that rating systems for hospitals could be developed in tandem with stringent hospital inspections. The aim of such a system would be to inform key stakeholders on the quality of care delivered by providers and to provide a method to prevent problems from developing, detect failure before harm is done and to facilitate a timely response. It is important to define whether hospitals perform at a similar level of outcome across a range of conditions, or whether individual providers encompass a range of performance levels, dependent on specialty [7,8,9]
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