The NHS Information Centre today publishes its first national summary of work to link hospital data (HES) with death records ² from the Office for National Statistics (ONS).

This includes never before ³ published data on deaths that occur outside of hospital after a patient had been discharged, which alongside new data about deaths occurring in hospital, provides an unprecedented picture of hospital patient outcomes ⁴.

Today's summary highlights national seasonal patterns in deaths within 30, 60 and 90 days of a hospital admission or procedure, alongside a detailed breakdown ⁵ of deaths following each specific type of procedure or diagnosis.

Initial findings – covering inpatient records from April 2007 to August 2010 ⁶ - show a greater percentage of patients die both in and outside of hospital after being treated in December compared to any other month, with this peak most pronounced in December 2008. Based on linked data:

• Deaths within 90 days of admission rose to 5.1 per cent (59,658) of all admissions in December 2008, compared to a monthly average figure of 4.1 per cent.
• Deaths within 90 days of a procedure rose to 4.8 per cent (35,212) of all procedures in December 2008, compared to a monthly average figure of 4.0 per cent.
• The same December pattern for deaths within 30 and 60 days occurred for both admissions and procedures.

The summary also shows that while most deaths which occur after an admission or procedure happen within hospital, a significant minority do not:

• Of all deaths recorded following an admission, the average monthly percentage occurring outside of hospital was 18.1 per cent after 30 days, 26.0 per cent after 60 days and 30.2 per cent after 90 days (figures are cumulative).
• Of all deaths recorded following a procedure, the average monthly percentage occurring outside of hospital was 17.6 per cent after 30 days, 26.1 per cent after 60 days and 30.6 per cent after 90 days (figures are cumulative).

NHS Information Centre chief executive Tim Straughan said: “The publication of this data means that for the first time, the NHS has access to new information on the pattern of deaths which occur both in and outside of hospital.

“This will allow researchers to examine the reasons behind the summary findings – such as if the December peak in deaths is due to the rise in general population deaths during the winter, or if other factors are responsible.

“It also means that for the first time comparisons can be drawn between deaths inside and outside of a hospital for different procedures and diagnoses.

“We intend to build on the summary findings to provide even more detailed information in the future, which will help the NHS to plan services effectively and offer high quality patient care.”

The report can be accessed here: www.ic.nhs.uk/pubs/provisionalmonthlyhes

ENDS

Notes to editors

1. The NHS Information Centre for health and social care (The NHS IC) is England's authoritative, central, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS IC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

2. Mortality data has been provided by the Office for National Statistics. ONS publishes mortality data based on calendar year of death registration. ONS provisional data has not been subject to full quality assurance and may not contain all deaths which were registered or which occurred during the period. Deaths which occurred in a given year may be registered in a subsequent year. The database remains open to accept these registrations so figures are subject to change. Figures may also change due to occasional upgrades to the linkage algorithm to enhance the way it operates. Any changes to the algorithm are detailed on the HES online mortality page

3. These data are labelled as “Experimental statistics” – which means they are new official statistics that are undergoing evaluation. A key part of the “Experimental statistics” label is user engagement in the evaluation of those statistics. The NHS IC invites readers to comment on this publication, which will help inform the next report. Comments may be sent to enquires@ic.nhs.uk.

4. Unadjusted data such as these are not recommended for comparing different organisations death rates with each other. This is because some organisations treat sicker patients who are more likely to die whether or not they enter hospital. For this purpose, standardised data enables a fairer comparison. However the unadjusted data can be used as a starting point for more detailed clinical analysis. It highlights the dataset as a valuable and rich source of information for gaining a greater insight into outcomes of patients within an organisation.

5. It is important to note that this high level analysis can't be used to infer that an admission or procedure caused the patient's death. For example, a patient admitted for a hernia operation (with a primary diagnosis of hernia) may die from an unrelated heart attack. The high percentages or counts of deaths after certain admissions or procedures should be considered in the context of the total number of patients with the condition and the nature of the condition as the health of some patients prior to entering hospital and prognosis will be expected to be poor simply due the condition they are suffering from. Further, the analysis is carried out at episode not patient level, so a patient and the associated death could be counted more than once if they have had more than one episode of care in hospital.

6. Monthly totals from April 2010 are provisional only. HES provisional monthly data can be used for high level, aggregate analysis demonstrating approximate trends in activity. Lower level analysis should be approached with caution as not all activity will be correctly processed until the final annual data is produced.

7. For media enquires please call 0845 257 6990 or contact mediaenquiries@ic.nhs.uk