North West London Hospitals NHS Trust, Harrow HA1 3UJ.
BMJ. 2010 Mar 31;340:c1234. doi: 10.1136/bmj.c1234.
To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage.
Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths.
Acute hospital trust in north west London.
Use of clinical guidelines in care bundles in eight targeted clinical areas.
Use of care bundles in treatment areas for the diagnoses leading to most deaths in the trust in 2006-7.
Change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardised mortality ratio (HSMR) during the intervention year compared with the preceding year. Effect of the change The standardised mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-8 for the HSMR diagnoses than if the 2006-7 HSMR had been applicable. From 2006-7 to 2007-8 there was a 5.7% increase in admissions, 7.9% increase in expected deaths, and 14.5% decrease in actual deaths.
Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.
在一家城市急症医院信托遭受负面媒体报道后，为降低住院死亡率并由此提高公众对患者护理质量的信心。
在干预年度使用了八项经证实可有效降低住院死亡率的治疗护理包；对干预护理包所针对的 13 项诊断、43 项非目标诊断以及涵盖医院 80%死亡病例的 56 项医院标准化死亡率比（HSMR）诊断的总体死亡率进行了调整死亡率（从医院发病统计数据得出）比较，以评估干预前一年的情况。
伦敦西北部的急症医院信托。
在 8 个目标临床领域中使用临床指南制定护理包。
在 2006-07 年导致信托机构死亡人数最多的诊断治疗领域中使用护理包。
目标和非目标诊断组的调整死亡率变化；干预年度与前一年相比的医院标准化死亡率比（HSMR）。
目标诊断的标准化死亡率（SMR）和 HSMR 均显示出显著降低，而非目标诊断则略有降低。累积和图显示，在质量改进的那一年，与前一年相比，13 项目标诊断中有 11 项的 SMR 显著降低。该信托机构的 HSMR 从 2006-07 年的 89.6 降至 2007-08 年的 71.1，成为英格兰急症信托机构中最低的。2007-08 年，HSMR 诊断的信托机构中发生的死亡人数减少了 255 人（其中 174 人在目标诊断中），而如果适用 2006-07 年的 HSMR，则死亡人数将增加。从 2006-07 年到 2007-08 年，住院人数增加了 5.7%，预计死亡人数增加了 7.9%，实际死亡人数减少了 14.5%。
实施护理包可以降低目标临床诊断领域和整个医院死亡率的死亡率。
