Hospitals asked to explain why death rates and admissions vary so widely

Hospitals are to be asked to explain their differing admission and death rates for common conditions after research found patient outcomes varied widely across the country.

Data compiled by the Department of Health shows death rates for heart attacks and strokes are three times higher in the worst performing hospitals than those with the best records.

Caesarean section rates in maternity services also vary from just over one in five women in the hospital with the lowest rate, to almost one in three in the hospital with the highest rate.

The research also shows someone with asthma is four times more likely to be admitted to hospital if they live in one county compared to another and that two-fold and three-fold variations exist in admissions for diabetes and lung disease.

Waiting lists for emergency hip fracture surgery vary too, from more than 95% of patients being operated on within the crucial 48-hour period in two of the country’s hospitals to just 66% in one hospital.

The Department of Health said there may be legitimate explanations for the differences, such as some hospitals automatically being sent the most serious cases with less successful outcomes inevitable.

But it also conceded the figures may reflect poorer standards of care in some hospitals, poorer availability of primary and community care resulting in more hospitalisations, or even the personal preferences and practices of individual doctors.

Chief medical officer Dr Tony Holohan said it was important that hospitals and health service providers begin to “unpick” the data and find out the reasons behind the variations.

“They need to be self-aware about that data and start to ask questions about their own performance and be aware of how they benchmark internationally to other hospitals of similar size as a prerequisite for starting to improve their quality of care,” he said.

In relation to the differing C-section rates in particular, he said he could offer no medical explanation.

“It’s unlikely to be explained by variations in the nature of the actual pregnancies and the complications associated with those pregnancies,” he said. “It can be variations in preference and practice by clinicians in relation to C-sections. What would concern me is that we have a variation in a particular clinical decision or pathway of care where there shouldn’t be such widespread variation.”

The data comes from the first report of the National Healthcare Quality Reporting System which covers the period 2011-2013 and which will produce annually updated statistics in relation to common activities in public hospitals as well as preventative measures such as immunisation and cancer screening programmes.


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