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ISD Scotland better information, better decisions, better health

Hospital Standardised Mortality Ratios

Quality Indicators

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

Quarterly Hospital Standardised Mortality Ratios (HSMR)

Latest Publications

Published: 27 May 2014
Hospital Standardised Mortality Ratios - Quarterly Statistics
Publication Summary Download pdf file [100kb]
Full Report Download pdf file [424kb]

The majority of deaths that occur in hospital are inevitable because of the patient's condition on admission. Some deaths can be prevented, however, by improving care and treatment or by avoiding harm.

In 2008, the Scottish Patient Safety Programme (SPSP) was established with the overall aim of reducing hospital mortality by 15% by 2012. This was then extended to a 20% reduction by December 2015. Since December 2009, Information Services Division (ISD) has published quarterly hospital standardised mortality ratios (HSMR) for all Scottish hospitals participating in the SPSP. Hospital Standardised Mortality Ratios (HSMR) are provided to enable these acute hospitals to monitor their progress in reducing hospital mortality over time.

The Scottish HSMR utilises the routine linkage of data obtained from hospital discharge summaries to death registrations from the National Records of Scotland. The HSMR is calculated for all acute inpatient and day-case patients admitted to all specialties (medical and surgical, excluding obstetrics and psychiatry). The calculation takes account of patients who died within 30 days from hospital admission. This means that the HSMR includes deaths that occurred in the community (out of hospital deaths) as well as those occurring in-hospital. Unlike similar indicators adopted in other parts of the UK, the Scottish HSMR is not a measure of all in-hospital mortality because it does not include patients that die in-hospital after 30-days from admission.

The Scottish HSMR is calculated by obtaining routinely collected death certificate data. These crude mortality data are adjusted to take account of some of the factors known to affect the underlying risk of death. Development of the case-mix adjustment methodology for Scotland began in early 2008. Although the method used in England at that time by Dr Foster informed the Scottish process, the models are different and reflect differences in the source data. Scottish HSMRs are therefore not directly comparable to those produced for English hospitals.

The latest report provides users with access to the same information as contained within a management information tool provided to NHS boards on 1st May 2014. It features the latest extension to the time series for the SPSP with observations at Scotland, NHS board and hospital levels from October-December 2006 through to October-December 2013. It also includes additional information and commentary on patterns of mortality over the longer term and by key demographic factors. There is information on the development of the measure, how it has been embedded in Scotland and how it compares to similar information used in other parts of the UK.

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