Mortality rates decreasing at Irish hospitals

Mortality rates declined for patients of five out of six medical conditions assessed for the audit. File picture.

The National Audit of Hospital Mortality shows improved mortality rates for patients across five of the six medical conditions assessed during 2019.

The audit looked at mortality rates over the last 10 years in public hospitals for heart failure, acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, chronic obstructive pulmonary disease (COPD) and pneumonia.

The rate only increased for one group of patients, those with COPD. This mortality rate increased from 33 deaths per 1,000 admissions in 2010 to 37 deaths per 1,000 admissions in 2019. This is an increase of 12% since 2010.

The biggest improvement was seen in mortality rates for ischaemic strokes which declined from 123 deaths per 1,000 admissions in 2009 to 76 deaths per 1,000, admissions in 2018, a decrease of 38%.

However, the report notes this positive trend could change as last year’s figures indicated 80 deaths per 1,000 admissions.

The auditors found a 23% reduction for heart failure-related hospital deaths, from 88 deaths per 1,000 admissions in 2010 to 68 deaths per 1,000 admissions in 2019.

The number of deaths from heart attacks decreased by 35% from 72 deaths per 1,000 admissions in 2010, to 47 deaths per 1,000 admissions in 2019.

Deaths where pneumonia was the main cause dropped from 142 deaths per 1,000 admissions in 2010 to 103 in 2019. This is a decrease of 27%.

The mortality rate for hemorrhagic stroke has not changed significantly over the decade, with a decrease from 264 deaths per 1,000 admissions in 2010 to 241 deaths per 1,000 admissions in 2019. This is a change of 9%.

Cork University Hospital and the Mater Hospital both reported statistical outliers in their findings, and have reviewed the data. The CUH review involved care for COPD patients. However, the audit states: “There were no issues of concern raised in any of the reviews.” 

Only 33 of the 44 public hospitals had enough patients in all categories to be assessed.

The audit is carried out by the National Office of Clinical Audit, who stated that hospital numbers cannot be directly compared. This is because different hospitals may treat older or more severely ill patients than others.

Almost all the hospitals were in the expected range for cardiovascular diagnoses, with smaller hospitals like Kerry General on the national average and larger hospitals like CUH and St James's in Dublin with an above-average number of deaths from this category.

Only hospitals with 100 or more heart failure admissions were counted, and all 31 were in the expected range. Ennis and CUH had above average mortality rates, while St John’s in Limerick and the Mercy Hospital were below average, reflecting the type of care offered at each.

Twenty-seven hospitals have stroke units but only 15 were counted due to low patient numbers at some units. The mortality rate at almost all was at or below the national average except for CUH, Tallaght University Hospital and St James's Hospital.

Pneumonia is more serious for older patients with 91% of the deceased aged over 65 across the 32 hospitals counted.

Work on improving the accuracy of palliative care reporting for this year’s audit was delayed by Covid-19 conditions.

Concern over rising COPD mortality rate

The National Hospital Audit of Mortality shows an increased rate of mortality for chronic obstructive pulmonary disease (COPD) patients which is ‘concerning’ according to a leading respiratory specialist.

COPD is one of the most common respiratory diseases in Ireland and the most common cause of adult emergency hospital admissions. Smoking is the most significant risk factor. An estimated 500,000 people have the disease.

The audit shows the rate of hospital mortality for this group increased by 12% between 2010 and 2019, from 33 deaths per 1,000 admissions in 2010, to 37 deaths per 1,000 in 2019. However, it shows the rate did not change between 2018 and last year.

Prof Tim McDonnell, respiratory consultant with St Vincent's Hospital, points out that people with severe COPD are extremely vulnerable to Covid-19.  Picture: Nick Bradshaw

Tim McDonnell, respiratory consultant with St Vincent’s Hospital and former HSE national clinical lead for COPD, said: “COPD mortality appears to be increasing. The reason probably is that COPD patients are getting older.” 

The audit shows 90% of the deceased were aged over 65 years.

“The figures are concerning," Prof McDonnell said. 

"When you hear about a trolley crisis in hospitals, you are talking about COPD. There are about 110,000 admissions each year with COPD, you’ve got to look at what is happening to those people.” 

The audit notes 39 deaths per 1,000 admissions at Cork University Hospital and their data was slightly above expected for two consecutive quarters, prompting an internal review. It states the hospital is also reviewing clinical governance of the service, training, and quality assurance processes.

People with severe COPD are extremely vulnerable to Covid-19. Some patients told Prof McDonnell this month they have only left their house two or three times since March.

He expects to see a lower mortality rate next year as a result of these extreme conditions. However, he said: “Psychologically, this can’t be good for them.”