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Domain 1 - Preventing people from dying prematurely

Domain 1 - Preventing people from dying prematurely

Links correct as of March 2020

Summary Hospital-level Mortality Indicator (SHMI)

The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at trust level across the NHS in England. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.  It covers patients admitted to non-specialist acute trusts in England who died either while in hospital or within 30 days of discharge.

SHMI values for each trust are published along with bandings indicating whether a trust's SHMI is '1 - higher than expected', '2 - as expected' or '3 - lower than expected'. For any given number of expected deaths, a range of observed deaths is considered to be 'as expected'. If the observed number of deaths falls outside of this range, the trust in question is considered to have a higher or lower SHMI than expected.

The SHMI value and SHMI banding for each trust can be found in the 'SHMI data at trust level' file. Trusts may be located at multiple sites and may be responsible for one or more hospitals.  A breakdown of the data by site of treatment is also available from this page.

The SHMI methodology does not make any adjustment for patients who are recorded as receiving palliative care. This is because there is considerable variation between trusts in the coding of palliative care. However, in order to support the interpretation of the SHMI, various contextual indicators are published alongside it, including indicators on the topic of palliative care coding.

The percentage of deaths with palliative care coded at either diagnosis or specialty level for each trust can be found in the 'Percentage of deaths with palliative care coding' file.

Historic SHMI and contextual indicator data is also available.

Guidance on how to accurately describe and interpret the SHMI is available to download from the SHMI homepage and trusts are strongly advised to consult the document 'SHMI interpretation guidance' prior to completing their Quality Account.

The England average SHMI is 1.0 by definition, and this corresponds to a SHMI banding of 'as expected'.  For the SHMI, a comparison should not be made with the highest and lowest trust level SHMIs because the SHMI cannot be used to directly compare mortality outcomes between trusts and, in particular, it is inappropriate to rank trusts according to their SHMI.

Trusts are advised to use the banding descriptions i.e. 'higher than expected', 'as expected', or 'lower than expected' in their Quality Account rather than the numerical codes which correspond to these bandings. This is because, on their own, the numerical codes are not meaningful and cannot be readily understood by readers.

Where trusts include other mortality indicators e.g. HSMR or RAMI in their Quality Account it is advised that some explanation of the main differences between these and the SHMI is provided to assist users.  Also, if trusts use sources of SHMI data in addition to NHS Digital's SHMI publication, the data source should be stated.

Patients on Care Programme Approach (CPA) followed up within 7 days of discharge from psychiatric inpatient stay

The percentage of patients on Care Programme Approach who were followed up within 7 days after discharge from psychiatric inpatient care during the reporting period.

Access the latest data.

Select the value from the "Proportion of patients on CPA who were followed up within 7 days after discharge from psychiatric inpatient care (QA)" column.

Technical definitions for this indicator can be found in the guidance document.

Category 1 mean response time; response within 7 minutes

The mean average response time across all C1 incidents that received a response on scene in the period should be in 7 minutes or less.

Access the data.

Within the "Ambulance Systems Indicators" file, select the value from the “Response times (mean)” column in the “Response times” tab under the ‘Category 1’ section.

Category 2 mean response time; response within 18 minutes

The mean average response time across all C2 incidents that received a response on scene in the period should be in 18 minutes or less.

Access the data 

Within the "Ambulance Systems Indicators" file, select the value from the “Response times (mean)” column in the “Response times” tab under the ‘Category 2’ section.
 

 

Patients with suspected ST elevation myocardial infarction who received the STEMI bundle

The proportion of patients with a pre-hospital diagnosis of suspected ST elevation myocardial infarction (STEMI), confirmed on ECG, who received the STEMI bundle, from the trust during the reporting period.   

Access the data

Within the "Ambulance Clinical Outcomes" file select the value from the "Proportion who received the STEMI bundle" column in the "Acute STEMI" tab. Note, from January 2018, STEMI care bundle data are collected for January, April, July, October.

Patients with suspected stroke assessed face to face who received the stroke diagnostic bundle

The proportion of suspected stroke or unresolved transient ischaemic attack patients, assessed face to face, who received the stroke diagnostic bundle.  

Access the data

Within the "Ambulance Clinical Outcomes" file select the value from the "Proportion who received the stroke diagnostic bundle" column in the "Stroke" tab. Note, after January 2018, Stroke diagnostic bundle data are collected for February, May, August, and November.

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Last edited: 20 April 2020 11:13 am