Re: Mortality indicators used to rank hospital performance
The authors do not consider the possibility that early post discharge deaths may reflect good, rather than poor practice. Most deaths in hospital are inevitable in the near future and good practice and organisation may ensure that death occurs at home as is universally accepted as the most favoured outcome. In this case the observed shorter lengths of stay would be anticipated.
Further. more good management leading to survival in the very frail increases the numbers at risk of short-term recurrence, which is more likely to be fatal. Although the adjustment lowers their rank by more accurately reflecting survival, the original higher ranking may still be a fairer assessment of their performance.
Competing interests: No competing interests