‘Minimal variation in COVID-19 mortality between trusts’, new study shows

GIRFT authors of variability in COVID mortality study

A new study from the Getting It Right First Time (GIRFT) programme – believed to be the largest analysis of COVID-19 hospital mortality in any country published to date – shows there was no evidence of unwarranted variation in rates of death for patients cared for in NHS hospitals across England during the first wave of the pandemic.

The observational study, published in the latest volume of The Lancet’s EClinicalMedicine journal, reports that between March and August 2020, 86,356 patients were discharged from hospitals in England with a confirmed diagnosis of COVID-19 – 26,929 (31.2%) of them died in hospital of all causes and 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death.

While early reports in 2020 suggested that some trusts had much higher death rates than others, the GIRFT study concludes that in-hospital mortality rates between the seven NHS regions in England and the 126 non-specialist NHS hospital trusts included in the analysis was modest. However, hospitals with more beds and a higher proportion of patients admitted to critical care had better outcomes.

Variability in COVID-19 in-hospital mortality rates between National Health Service trusts and regions in England is the result of work by a pool of GIRFT analysts and clinicians –  including senior research associate William Gray, honorary fellow Annakan Navaratnam, retired chief information officer Jamie Day and GIRFT chair Tim Briggs – along with colleagues from University College Hospital and King’s College Hospital in London.

GIRFT is now using the data to help trusts to understand clinical and strategic approaches that have been successful in the management of COVID-19 patients to prepare for future surges.

Professor Briggs, who is also the National Director of Clinical Improvement for the NHS, said: “The rapid and prolonged increase in patient flow during the first wave of the pandemic strained hospital systems everywhere, but there are now opportunities to learn from the experience of individual trusts and regional networks to help prepare the NHS for the management of COVID-19 patients during future surges.

“Understanding the experience of staff and wider systems at a regional, trust and hospital level, and exploring the reasons for any smaller variations with clinicians, is now crucial to ensure that lessons are learned.”

The new study for EClinicalMedicine follows last month’s GIRFT study into Patient factors and temporal trends associated with COVID-19 in-hospital mortality in England, published in The Lancet (Respiratory Medicine).

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