| There has been a significant reduction (35%) in in-hospital mortality for acute myocardial infarction (AMI) over the past 10 years, from 74 deaths per 1,000 admissions in 2009 to 48 deaths per 1,000 admissions in 2018.
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| There was a 6% (not significant) reduction in in hospital mortality for heart failure over the past 10 years, from 82 deaths per 1,000 admissions in 2009 to 77 deaths per 1 ,000 admissions in 2018
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| There was a significant reduction (38%) in in-hospital mortality for ischaemic stroke over the past 10 years, from 123 deaths per 1,000 admissions in 2009 to 76 deaths per 1,000 admissions in 2018, and this reflects the results reported in the National Stroke Register in 2018.
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| There was a 17% reduction in inhospital mortality for haemorrhagic stroke over the past 10 years, from 302 deaths per 1,000 admissions in 2009 to 252 deaths per 1,000 admissions in 2018.
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| In comparison to other conditions, there was no reduction (0%) in in-hospital mortality for chronic obstructive pulmonary disease (COPD) over the past 10 years, with 37 deaths per 1,000 admissions in both 2009 and 2018.
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| There was a significant reduction (28%) in in-hospital mortality for pneumonia over the past 10 years, from 145 deaths per 1,000 admissions in 2009 to 104 deaths per 1,000 admissions in 2018.
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| On the SMR funnel plot for pneumonia on page 41 two hospitals are outside the 99.8% control limits. The first hospital, Cork University Hospital, had a statistical outlier for pneumonia in 2018; it engaged with NOCA and conducted a preliminary review. The second hospital, St James’s Hospital, was not a statistical outlier for monitoring and escalation in 2018. Its SMR on the funnel plot displays the first quarterly period where the SMR and cumulative summary control chart (CuSum) are outside the 99.8% limits, and therefore it does not meet the definition of a National Audit of Hospital Mortality (NAHM) statistical outlier (high SMR and CuSum breach occurring in two consecutive quarterly periods).
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| Commentary from our user representative on page 16 shows evidence that there is still a requirement to improve consistency of the principal diagnosis in patient’s health care records.
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| There is a year-on-year rise in the national mean rate of application of the palliative care code for patients who die. This rise is most likely due to the awareness raised about the palliative care code and its potential importance to the NQAIS NAHM risk modelling.
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| During 2019, NAHM data were included as the source for a mortality indicator in the Hospital Patient Safety Indicator Report (HPSIR) – a monthly report of collated key performance indicators in a hospital, which is signed by the hospital CEO/General Manager and published on the Health Service Executive (HSE) website. The inclusion of NAHM data in the HPSIR report will ensure that in-hospital mortality data are continually monitored.
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| Enhancements to the NQAIS NAHM web-based analytical tool were released to the live server in Q3 2019. These enhancements were advanced with input from system users and from the Health Intelligence Unit, Strategic Planning and Transformation, HSE, (HIU) and the functionality has greatly improved as a result. The new summary page allows a hospital a quick means to view whether it is an outlier or not. This is invaluable to managers and clinicians for their quality improvement work. These enhancements have enabled a much better user experience, with new views and functionality. See Table 4 on page 46 of the main report for more information. Throughout 2019, training on the enhanced NQAIS NAHM tool took place in various locations nationally.
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