Background In March 2015 The Department of Health published the first annual report of the “National Healthcare Quality Reporting System.” This was designed to report the quality of healthcare provided across all sectors of our system. The measure of acute cardiac care was in-hospital mortality within 30 days of admission for acute myocardial infarction (AMI). Data was collected via HIPE data by the Healthcare Pricing Office (HPO), an administrative branch of the Health Service Executive. The national average was found to be 6.8 deaths per 100 cases. Connolly Hospital Blanchardstown was one of three hospitals that had age-sex standardised mortality rates that were statistically significantly higher than the national average with a rate of 9.87 deaths per 100 cases. Our audit aimed to assess the accuracy of the findings.
Methods Patients were identified by searching the HIPE system for patients who had been labelled with a primary diagnosis of AMI and had died within 30 days of this diagnosis between 2011 and 2013. We then performed a chart review and examined patients’ death certificates.
Results 42 patients were classified by HIPE as having had a primary diagnosis of AMI with mortality within 30 days. Only 23 (54.8%) of these patients were confirmed as having had an AMI as per WHO criteria during the course of their admission, 22 by chart review and one by post-mortem. Of these patients, twenty (87%) died within 30 days of their AMI. Patients who died post AMI were more likely to have been seen by cardiology services (87% vs 57.9%), to have had palliative care review (60.9% vs 36.8%) and to have been determined not for resuscitation (78.3% vs 42.1%). We found that twelve patients had AMI placed as a cause of death (10 primary cause, 2 antecedent cause) on death certificate despite having not suffered AMI during their hospital admission. If the 22 patients incorrectly coded were excluded from the AMI data, the mortality rate within 30 days post-AMI in CHB would fall to 4.14 deaths per 100 cases, well below national average.
Conclusions Analysing the performance of our healthcare system is imperative to provide a quality service to our patients and to improve our healthcare service. The analysis of data however is only useful if the data itself is accurate. Our audit showed that many of the patients coded as having had a primary diagnosis of AMI by HIPE had not in fact suffered AMI, and some of those who had, did not die within 30 days of the event. It would be our hope that the discrepancies shown in this audit would feed back to the HSE to enable a more accurate data-entry in the future and also to NCHD training programmes with instruction in particular on the importance of the accurate documentation of diagnoses and completion of death certificates. The findings of our audit underline the need to ensure that the data collected accurately represents outcomes, the responsibility for which lies with both clinicians and coding staff.
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