CRAM chart detects increase in number of surgical deaths

CRAM chart detects increase in number of surgical deaths

Mortality tables are one of the new measures of performance being introduced by the NHS Executive, but comparisons will misleadif differences in case mix are not allowed for. Even within heartsurgery, the annual mortality for all patients and operationsmay not be a particularly helpful statistic. On p 1697 Polonieckiet al explore the case specific chances of surviving an adultheart operation at a particular hospital and how this varied overfour years by using a cumulative risk adjusted mortality (CRAM)chart. They conclude that surgeons should use such a statisticalquality control scheme. Continuous surveillance of this kind is,so they argue, the only means of providing a patient with a realisticestimate of the chances of surviving surgery at the chosen hospital.

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Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery: J Poloniecki, O Valencia, and P Littlejohns
BMJ 1998 316: 1697-1700. [Abstract] [Full Text] [PDF]