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National hospital mortality surveillance system: a descriptive analysis
  1. Elizabeth Cecil1,
  2. Samantha Wilkinson2,
  3. Alex Bottle1,
  4. Aneez Esmail3,
  5. Charles Vincent4,
  6. Paul P Aylin1
  1. 1 Primary Care and Public Health, Imperial College London, London, UK
  2. 2 Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  3. 3 Health Services Research and Primary Care, University of Manchester, Manchester, UK
  4. 4 Experimental Psychology, University of Oxford, Oxford, UK
  1. Correspondence to Elizabeth Cecil, Primary Care & Public Health, Imperial College London, London W6 8RP, UK; e.cecil{at}


Objective To provide a description of the Imperial College Mortality Surveillance System and subsequent investigations by the Care Quality Commission (CQC) in National Health Service (NHS) hospitals receiving mortality alerts.

Background The mortality surveillance system has generated monthly mortality alerts since 2007, on 122 individual diagnosis and surgical procedure groups, using routinely collected hospital administrative data for all English acute NHS hospital trusts. The CQC, the English national regulator, is notified of each alert. This study describes the findings of CQC investigations of alerting trusts.

Methods We carried out (1) a descriptive analysis of alerts (2007–2016) and (2) an audit of CQC investigations in a subset of alerts (2011–2013).

Results Between April 2007 and October 2016, 860 alerts were generated and 76% (654 alerts) were sent to trusts. Alert volumes varied over time (range: 40–101). Septicaemia (except in labour) was the most commonly alerting group (11.5% alerts sent). We reviewed CQC communications in a subset of 204 alerts from 96 trusts. The CQC investigated 75% (154/204) of alerts. In 90% of these pursued alerts, trusts returned evidence of local case note reviews (140/154). These reviews found areas of care that could be improved in 69% (106/154) of alerts. In 25% (38/154) trusts considered that identified failings in care could have impacted on patient outcomes. The CQC investigations resulted in full trust action plans in 77% (118/154) of all pursued alerts.

Conclusion The mortality surveillance system has generated a large number of alerts since 2007. Quality of care problems were found in 69% of alerts with CQC investigations, and one in four trusts reported that failings in care may have an impact on patient outcomes. Identifying whether mortality alerts are the most efficient means to highlight areas of substandard care will require further investigation.

  • hospital mortality
  • quality of care

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  • Contributors All authors contributed to the conception and design of this study. SW carried out data collection at the Care Quality Commission. EC carried out the data analysis. All authors took part in interpreting the data for this study. All authors commented on and helped to revise drafts of this paper. All authors have approved the final version.

  • Funding This study was funded by the National Institute for Health Research, Health Servicesand Delivery Research Programme (HS&DR - 12/178/22).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author), and PPA and AB declare that they are partially funded by grants from Dr Foster Intelligence, an independent healthcare information company. CV reports funding from the Health Foundation for Research and Haelo (a commercial innovation and improvement science organisation) for consultancy work. EC, SW and AE declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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