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We are pleased that findings from our Preventable Incidents, Survival and Mortality Study (PRISM) study1 are consistent with Nash and Quinn's clinical experience. They raise the important point that published variation in hospital standardised mortality ratios (HSMRs) and its recent modified version, the summary hospital-level mortality indicator, between acute trusts and within individual trusts over time, is greater …
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.