Hospital revises its own data in government league table

EDITOR—The government has placed great emphasis on hospital league tables, although potential and real flaws have been identified. We therefore thought it was appropriate to review our hospital's process, assessing the accuracy of the mortality data in general surgery and the quality of patient care.

The data submitted included several patients who had undergone procedures that were specifically excluded. In the non-emergency group this would have reduced the number of patient deaths from 32 to 24 and in the emergency group from 121 to 100. In addition, the government guidelines can be ambiguous in defining minor operations. It seems unreasonable to include diagnostic or palliative procedures such as paracentesis. Such exclusions would have further reduced the deaths from 24 to 20 in the non-emergency group, and from 100 to 89 in the emergency group. Overall reductions would have been 37.5% and 26.5% in the respective groups. We have been unable to calculate the potential change in our league table positions as the government's demographic correction factors are not readily obtainable.

An independent review of the case records of all deaths was undertaken by a panel of clinicians. Areas of concern were identified in 28 out of 9380 patients who underwent a procedure. The criticism in most of these cases was a failure by junior staff to recognise significant physiological deterioration; as a result senior staff was not contacted. The benefits of using an early warning scoring system have been shown to identify these cases, and increased emphasis has been made to ensure that this method of assessment is used regularly in all patients.1 This in turn should ensure appropriate involvement of senior staff.

Most patients have little choice but to attend their local hospital. If it seems that any hospital is underperforming, it will produce an illogical fear in the public eye. Fears regarding standards of local health care may be exacerbated by inaccurate government statistics. Small numbers, dubious statistics, and classification errors lead to potentially large differences in the position in league tables.

We recommend that data for submission should be assessed by an appropriately clinically qualified individual and the published list of exclusion procedures should be clarified and regularly revised.