Response to BMJ paper on identifying outliers and Clinical Outcomes Publication

Category: Medical Directors Blog

A study published today in BMJ Open has questioned whether publishing individual consultants’ mortality data – such as Clinical Outcomes Publication, managed by HQIP on behalf of NHS England – is reliable in indicating how well those consultants are performing.

A response from HQIP medical director Professor Danny Keenan:

Clinical Outcomes Publication (COP – part of the Government’s Transparency initiative, in 13 surgical and cardiological specialties) is designed to promote best practice in interventional procedures. It is not designed to track individual surgeons' mortality rates as in the vast majority of surgery, the mortality rate is vanishingly low.

Current methodology, which has been tried and tested, has identified, in higher risk specialties (such as open heart surgery and complex vascular surgery), both individuals and hospitals outside of expected ranges for mortality and other aspects of care. Here mortality reporting is a vital marker of quality (both of individuals, teams and hospitals). We have identified several ‘outliers’ and as a result hospitals have completed initiatives demonstrating improved performance, both in the hospital and with individual surgeons.

Furthermore, COP is just one part of a detailed set of processes to review standards of care. All interventional specialties rely on multiple other techniques to assure themselves and patients that they are offering high quality intervention. We are confident that these techniques are being triangulated with other medical measures and organisation-specific concerns.

The vast majority of surgery does not deal with high risk procedures and here individual and team mortality is an assurance tool that patients would expect to be watched. It is not used solely as a marker of individual performance as the mortality rates, thankfully, are very small. Patient reported outcomes can be very important and our orthopaedic colleagues, for instance, have done a lot of work here following hip and knee replacement.

In conclusion, post-operative mortality, both institutional and individual, is most useful as a marker of a surgeons’ performance in certain high risk specialties. Overall, surgeons in Britain need to be commended that their attention to all markers of quality, both institutional and individual, has contributed to improved results, including mortality.

Professor Danny Keenan, medical director, HQIP



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