• John Wright, Bob Dugdale, Ian Hammond, Brian Jarman, Maria Neary, Duncan Newton, Chris Patterson, Lynne Russon, Philip Stanley, Rose Stephens, and Erica Warren.
• Clinical & Scientific Support Services, Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ. John.Wright@bradfordhospitals.nhs.uk
• J R Soc Med. 2006 Jun 1; 99 (6): 303-8.

ProblemThere are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care.SettingA large acute hospital in an urban district in the North of England.DesignBefore and after evaluation of a hospital mortality reduction programme.Strategies For ChangeAudit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control.EffectsHospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005.Lessons LearntImproving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality.

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