Increased collaboration between clinicians and clinical coders (or where available coders assigned to a speciality) will improve the quality of medical records and coding of hospital data in the Hospital In-Patient Enquiry system (HIPE).

NAHM should be used by clinicians, hospital managers and their boards as a quality improvement tool for the targeted review of hospital mortality patterns.

Hospitals should always triangulate NAHM to other data sources within their hospital and other national data collections. This can include a broader context of quality tools, such as patient experience and complaints, staff feedback and safety incident reporting.

Guidance aimed at clinical coders is required from both the HSE National Clinical Programme for Palliative Care on interpretation of clinical documentation and the HPO on use of the palliative care code.

The NAHM Governance Committee should commission a short life working group with the HSE National Clinical Programme for Palliative Care and the HPO to examine the possibility of including a palliative care speciality clinical code in NQAIS NAHM.

The NAHM Governance Committee should commission a research study to investigate the changes in hospital admissions and crude mortality rates in key diagnoses presented in this report.

The NAHM Governance Committee, working with international experts, should examine a process to enable the validation of NAHM data following closure of the HIPE file.

The possibility of an illness severity score within the NQAIS NAHM tool should be explored by the NAHM Governance Committee.