Provisional results of the Danish campaign

The campaign has reached its end and the final results have been published. The objective of Operation Life was to prevent 3000 deaths from April 2007 to April 2009. The Danish hospitals have joined the campaign actively. More than 100 wards throughout the country have taken part in the campaign. The progresses have been measured in several ways:

	1. HSMR (Hospital Standardised Mortality Ratio): New HSMR-figures were published every quarter throughout the duration of Operation Life. Operation Life has published HSMR-figures measuring the mortality rate in Danish hospitals in 2006. The 2006-figures are used as baseline for the measurements of the campaign results. The national HSMR-level of 2006 is per definition 100 (%).The number of saved lives has accelerated during the campaign. The final Hospital Mortality Rate (HSMR) published June 2009 shows that the Danish hospitals have saved 1654 more lifes when compared to 2006 (read more below).
	2. Process-indicators: Departments and wards, working with Operation Life, type in the data for the implementation of the 6 clinical bundles. For this campaign a database has been established, where the participating wards and departments can report their results on how it goes with the implementation. It is compulsory to report data of one process indicator for each bundle required. The database is only accessible for the participating wards/departments/hospitals. The wards, departments and hospitals can monitor their own figures from the database and accordingly follow their own development through the whole duration of Operation Life. For instance it is possible to compare the figures on the degree of implementation from the department in question with the figures of the national average. It is not possible to access the figures from other individual departments than your own. The compulsory indicator is described in the clinical manuals composed for each bundle. The participating wards and departments are granted access to the database by the campaign secretariat. The data reported to the Operation Life database shows that the top score bundle in compliance – the AMI bundle has increased from 63 % to 84 % (the compliance for May 2008 is 90 %). And the top improvement bundle in compliance – the ventilator bundle has increased from 18 to 61 %.
	3. Result indicators: of the departments and wards involved with Operation Life, there are many who, on their own, lay down and measures result indicators of the 6 bundles. I.e. the number of ventilator hours in connection with the ventilator bundle or the number of cardiac arrests in connection with the Rapid Response Team (RRT). During the campaign, 14 Danish hospitals have implemented Rapid Response Teams and 5 more are planning their implementation at this very moment. In the hospital of Sydvestjysk Sygehus, Esbjerg, they can tell that the number of call for the cardiac arrest-team has decreased significally during the period in which they have had their Rapid Response Team.

1. HSMR-figures 

The campaign started on April 16th 2007, and therefore the 2nd quarter 2007 equals 1st quarter of the campaign.

Now the figures for the four quarters of 2007 are present together with the four quarters of 2008. Operation Life publishes the figures at the regional scale, and each of the regions and hospitals have access to their own figures at hospital level.

The number of saved lives has accelerated during the campaign. The final Hospital Mortality Rate (HSMR) published June 2009 shows that the Danish hospitals have saved 1654 more lifes when compared to 2006.

The HSMR-figures are not intended to be cross-compared.

HSMR is not a definitive measurement for the quality of a single hospital – or region. There are differences between the individual hospitals and their patients. This is a difference the model does not take into consideration. It is therefore dissuaded, that HSMR-figures are used to make mutual comparisons between regions and hospitals. The figures are to be regarded only as a working tool for monitoring the development over time within each individual region and within each individual hospital.

About the statistical uncertainty

HSMR-measurement is encumbered with statistical uncertainty. For each HSMR-figure a security interval is stated. The more patients involved in the calculation, the more statistical certainty is obtained - and the more narrow will be the security interval. When HSMR is measured for a whole year, the security interval is tighter than when it is measured for only a quarter.

When two HSMR-figures are compared, e.g. when the figure for 2nd quarter 2007 are compared to the baseline of 2006, there is no statistical difference on the figures if one figure is within the security interval of the other figure.

The quarter-figures are seasonally adjusted.

Normally there is a seasonally determined variation of the mortality rate in hospitals. The mortality rate is highest in winter. The new quarter-figures are adjusted to meet this seasonally determined variation.

As mark for the expected mortality in a specific quarter, the figures from the whole country (2006) of the corresponding quarter are used as standard of reference.

This means that the new quarter-figures are directly comparable with the 2006 baseline.