Retrospective cohort study of false alarm rates associated with a series of heart operations: the case for hospital mortality monitoring groups.
OBJECTIVE
To examine the efficacy of different methods of detecting a high death rate and determining whether an increase in deaths after heart transplantation could be explained by chance.


METHODS
Retrospective analysis of deaths after heart transplantation. Seven methods were used: mortality above national average, mortality excessively above national average, test of moving average mortality, test of number of consecutive deaths, sequential probability ratio test (SPRT), cusum graph with v-mask, and CRAM chart. The national average mortality was not available and a rate of 15% was used instead as the benchmark.


METHODS
Regional cardiothoracic unit.


METHODS
All 371 patients who received a heart transplant in the programme, 1986-2000.


METHODS
30 day survival after transplantation.


RESULTS
All methods provided evidence that the 30 day mortality had been high at some stage. The probability that the finding was a false positive depended on which test was used. At the end of the series the average mortality, sequential probability ratio, and cusum tests indicated a level of deaths higher than the benchmark while the remaining four tests yielded negative results.


CONCLUSIONS
If the decision to test for outlying mortality is made retrospectively, in the light of the data, it is not possible to determine the false positive rate. Prospective on-site mortality monitoring with the CRAM chart is recommended as this method can quantify the death rate and identify periods when an audit of cases is indicated, even when data from other institutions are not available. A hospital mortality monitoring group can routinely monitor all deaths in the hospital, by specialty, using hospital episode statistics (HES) data and appropriate statistical methods.
Poloniecki
Jan
J
Community Health Sciences, St George's Hospital Medical School, London SW17 0RE. j.poloniecki@sghms.ac.uk
Sismanidis
Charalambos
C
Bland
Martin
M
Jones
Paul
P
D015331:Cohort Studies; D005189:False Positive Reactions; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate