Using hospital mortality rates to judge hospital performance: a bad idea that just won't go away
BMJPublished 20 April 2010
Richard Lilford, Peter J. Pronovost
Citations278
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TL;DR
Standardised mortality rates are a poor measure of the quality of hospital care and should not be a trigger for public inquiries such as the investigation at Stafford Hospital, say Richard Lilford and Peter Pronovost.
Abstract
Twelve patients with small burr hole skull defects after extra-intracranial arterial bypass surgery were studied. The amplitude and frequency of the sensorimotor rhythm were measured 7 days and 1, 2, 4, and 6 months after surgery in follow-up EEGs from the central region. Seven patients showed a frequency decrease (compared with preoperative measurement) on the operated side 7 days and/or 1 month after surgery. There was no case of frequency decrease 6 months after surgery; four patients displayed a late frequency increase. Ipsilateral amplitude enhancement was never found 7 days postoperatively, but after 6 months in nine patients. Such physical factors as burr holes and bone replacement can only partially explain the amplitude enhancement, and cannot explain the frequency decrease. It may be assumed that temporary clamping of the middle cerebral artery and/or reperfusion of an ischaemic area result in a brief deterioration of brain function, as indicated by frequency slowing and delayed amplitude enhancement; related observations were made in patients with cerebrovascular disorders and mild to moderate neurological deficit about 20 days after the onset and correlated with clinical recovery.
Keywords
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