A study published on bmj.com reports that patient deaths have been cut by almost 15 percent at three London hospitals after the introduction of treatment checklists, known as care bundles.

The researchers suggest that their methods could be used to reduce mortality in many other hospitals.

The North West London Hospitals NHS Trust serves a population of about 500,000 at three sites: Northwick Park Hospital, Central Middlesex Hospital and St Mark’s Hospital. Between 2005 and 2006, the trust was the focus of a series of adverse media stories. This impacted on staff morale and also on patients’ perceptions of care.

A group of senior clinicians set out to increase public confidence in the quality of patient care at the trust by reducing hospital inpatient mortality.

Eight care bundles were developed for thirteen diagnostic areas with the highest number of deaths at the trust from 2006 to 2007. These included treatments for stroke, heart failure and chronic obstructive pulmonary disease (COPD).

Care bundles are a group of treatment checklists based on clinical guidelines. When combined, the effectiveness and safety of patient care are improved.

Adjusted hospital mortality during the year the care bundles were introduced was then compared with the previous year using the hospital standardized mortality ratio (HSMR).

The HMSR is a comparative measure of a hospital’s overall mortality. It focuses on a group of diagnoses that account for 80 percent of all hospital deaths nationally. It provides a tool for analyzing hospital outcomes over time.

The results indicate that the overall HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8. It became the lowest among acute trusts in England.

In 2007-8, 174 fewer deaths occurred in the trust in the targeted diagnoses. In addition, 255 fewer deaths occurred in the HMSR diagnoses compared to 2006-7. From 2006-7 to 2007-8, this represents a 14.5 percent decrease in actual deaths.

The authors conclude that this study demonstrates that it is possible to target care bundles across a wide range of diagnoses in a busy acute hospital trust. Moreover, this can be associated with a significant reduction in mortality in the targeted diagnostic areas. They say in closing that these methods could also be applicable in general.

“Using care bundles to reduce in-hospital mortality: quantitative survey”
Elizabeth Robb, director of nursing, visiting professor, Brian Jarman, emeritus professor, part-time senior fellow, Ganesh Suntharalingam, clinical director and consultant in intensive care medicine, Clare Higgens, clinical director, director of medical education, and consultant physician, Rachel Tennant, consultant physician, Karen Elcock, director of practice and work based learning
BMJ 2010; 340:c1234
bmj.com

Written by Stephanie Brunner (B.A.)