Better drugs and technology leading to fewer deaths in hospitals

There is nothing more likely to drive hospital managers and many of their staff apoplectic than talk of league tables to compare performance.

And yet a lack of publicly available comparative data about outcomes in the Irish health service is one of the main factors hindering improvements. It also does patients a disservice by leaving them in the dark about standards at their local facilities, thereby allows anecdote and rumour to have the upper hand over hard data.

We do count trolleys, of course, but the focus on the number of patients waiting for admission can tend to obscure the fact that many other things are going on in hospitals that need to be measured and rated.

The Irish health service is still relatively poor at measuring things compared to, say, Britain’s national health service, but the situation is improving.

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So much so that there are now two annual reports into mortality at Irish hospitals, one from the Department of Health and another from the National Office of Clinical Audit (Noca).

The Noca audit, published today, looks at patterns and trends of patients who die in hospital from six medical conditions: heart attack, heart failure, stroke – ischaemic and haemorrhagic – chronic obstructive pulmonary disease (COPD) and pneumonia.

Death rate

The good news is that the past decade has seen falls in the death rate for most of these conditions. In some cases, these reductions are highly significant – 35 per cent for heart attack, and 38 per cent for ischaemic stroke. These improved outcomes, which translates into hundreds of lives saved every year, are the result of better drugs and technology, and better organisation of services so that seriously ill patients get the medical help they need as quickly as possible from the most appropriate and highly trained medical staff possible.

The most disappointing figures are for COPD, a lung condition marked by shortness of breath and chest tightness and often linked to smoking. Unfortunately, Ireland has one of the highest rates internationally for COPD hospitalisations and we have been slow to wake up to the need to integrate and improve services in order to deliver better outcomes for patients.

Despite this, our COPD mortality figures have not improved over the past decade, the report shows.

This audit comes with all sorts of caveats and its authors say it should not be used to compare hospitals against each other. Though there are variations in hospital performance for each of the six conditions, the only real outlier identified in the report is the above expected rate of pneumonia deaths at Cork University Hospital, which is being investigated.

This is encouraging news, though it would be good to see the mortality rate figures for individual hospitals controlled for variables such as intake so that more meaningful comparisons could be made.