Large disparities in key patient care indicators across trusts in England have been revealed in data shared exclusively with HSJ.
The figures, prepared by health analytics firm Dr Foster Intelligence, compares the actual rate of pressure sores and accidental lacerations between February 2010 and January 2011 with an expected rate, based on previous performance and other controlled factors.
Six strategic health authorities recorded pressure sore rates rated “high” risk, with the East Midlands, Yorkshire and the Humber and South Central falling within the expected range and the South West banded as “low” risk.
The five trusts recording the highest rates of pressure ulcers against their expected rates were Warrington and Halton Hospitals Foundation Trust, Medway Foundation Trust, Southend University Hospital Foundation Trust, Royal Bolton Hospital Foundation Trust and West Hertfordshire Hospitals Trust.
Dr Foster director of research Roger Taylor said: “Data quality around pressure sores is not currently accurate enough. Trusts may be rated high due to effective coding and others rated low through ineffective coding practices.
“It is also true that coding is not clear around where the pressure sore was obtained. By publishing this data we hope to inspire trusts to improve coding in this area and to begin using ‘present on admission’ flags to help give a clearer picture of in-hospital care.”
Care Quality Commission regulatory policy manager Karen Wilson said pressure sores were often an indicator of overall quality.
She said: “It’s generally recognised as a measure of whether an organisation is keeping on top of things. Sometimes it goes along with issues around nutrition.”
Royal Bolton Hospital‘s deputy director of nursing Maria Sinfield said 41 per cent of patients included in the Dr Foster data had developed ulcers before admission.
She said: “Of the remainder, we found issues with our recording of how severe or otherwise the sore was – one even included a patient whose nose was reddened by their spectacles.”
However, the trust has reinforced the importance of risk assessment on admission and appropriate care plans and spent around £1m on new beds with pressure relieving mattresses.
Southend University Hospital’s director of nursing Sue Hardy said: “A full audit of the underlying data is being undertaken to identify any significant trends which are contributing factors, allowing us to understand and improve where necessary.”
A spokesman for Warrington and Halton Hospitals said a high proportion of cases had been acquired in the community. The trust has reviewed its coding and set a 30 per cent reduction target for this year.
A spokeswoman for Medway Foundation Trust also said the analysis did not distinguish hospital and community acquired pressure sores. The trust was discussing “discrepancies in the coding process” with Dr Foster.
There was also high variation around numbers of accidental cuts, punctures, perforations and lacerations. Of the 150 acute providers listed on Dr Foster’s database, 43 were rated “high risk”, with the rest low or in “within the expected range”.
Across the 10 strategic health authorities the composite scores found four rated high risk, three low and three within the expected range.
The information was collated from Secondary Uses Service data on two of Dr Foster’s 14 patient safety indicators.
- Acute care
- Andrew Lansley
- BOLTON NHS FOUNDATION TRUST
- Bruce Keogh
- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- MEDWAY NHS FOUNDATION TRUST
- Patient safety
- SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
- Stephen Thornton
- WARRINGTON AND HALTON FT
- WEST HERTFORDSHIRE HOSPITALS NHS TRUST
- Winter pressures