Significant variation in hospital death rates, report reveals

A number of hospitals have significantly higher death rates due to heart attacks and strokes than the national average, according to a new report from the Department of Health.

The rate at which patients die in hospital from heart attacks (acute myocardial infarction) has dropped 40 per cent in a decade and the Irish mortality rate is well below the OECD average.

However, three hospitals - Midland Regional in Tullamore, Connolly Hospital in Blanchardstown and Cavan General - had significantly higher rates compared to the national average.

The Mater Hospital in Dublin, Midland Regional Hospital in Portlaoise and Kerry General Hospital recorded the lowest death rates within 30 days of admission for a heart attack.

The figures are contained in the first annual report of the National Healthcare Quality Reporting System, which measures the performance of the health service across a number of indicators.

Haemorrhagic stroke

The Irish death rate for haemorrhagic stroke is above the OECD average and has remained unchanged over the past decade.

One hospital, Naas General, and one hospital group, Ireland East, had rates that were significantly higher than the national average. The lowest rates were in Beaumont Hospital in Dublin, and in Cavan.

For strokes caused by clots (ischaemia), Cork University Hospital and Cavan were significantly above average, while Tallaght Hospital had the lowest rate. Ireland's death rate from ischaemic stroke has fallen but is still above the international average.

The report says differences may arise for many reasons, and not just because of the quality of care provided. It says the indicators measured act like smoke alarms by attracting attention and enabling people to determine whether the problem is caused by smoke (lesser urgency) or fire (priority for action).

Wide variations

The report identifies wide variations across geographic areas for a variety of indicators, the reasons for which need to be explored further.

For example, there was a three-fold variation in the rate of hospitalisation for people with COPD (chronic obstructive pulmonary disease) between the lowest county, Kerry, and the highest, Offaly.

There was a four-fold variation in the rate of hospitalisation for asthma between the lowest county, Monaghan, and the highest, Longford. For diabetes hospitalisation, the variation was two-fold, between the lowest county, Leitrim, and the highest, Carlow.

One hospital - Cork University - carried out 66 per cent of hip fracture surgeries within two days of admission, while two hospitals - St Vincent’s in Dublin and Mayo General - achieved rates of over 95 per cent within two days.

Caesarean section

The rate of caesarean section varies from 21 per cent in Sligo General to a high of 35.4 per cent in St Luke’s, Kilkenny.

Roscommon had the highest uptake of the MMR and Meningococcal C vaccines for two-year-old children, while West Cork had the lowest uptake for the latter vaccine.

The report says some areas of the health service are performing well.

Immunisation rates have improved, death rates from heart attacks have fallen, survival rates from cancer are improving and the incidence of hospital acquired infections has dropped sharply.

Areas where there is room for improvement are also identified. These include cervical cancer survival rates, falling uptake of breast cancer screening and variations in many of the indicators, as referred to above.