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Hospital Standardized Mortality Ratio (HSMR)
How is the HSMR rate calculated?
HSMR stands for Hospital Standardized Mortality Ratio and is a mathematical calculation that shows the actual number deaths versus the expected number of deaths.
The HSMR number is determined using a complicated mathematic calculation that takes into consideration a number of variables including timeliness of physician chart completion, how thoroughly the physician has documented findings in the chart, and which diagnosis the physician chose to account for the patient’s hospital stay. It is the actual number of deaths divided by the expected number of deaths. The number of expected deaths is complicated as it is based on patient groups that account for 80% of deaths in acute care hospitals. In addition, the HSMR takes into account factors that affect mortality such as age, gender and length of stay.
The rate is calculated as follows:
Actual number of deaths among diagnosis groups
accounting for 80% of inpatient mortality x 100
Expected number of deaths among diagnosis groups
accounting for 80% of inpatient mortality
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An HSMR equal to 100 indicates that there is no difference between the hospital’s mortality rate and the average mortality rate; greater than 100 indicates that the local mortality rate is higher than the average mortality rate; and less than 100 indicates that the local mortality rate is lower than the average mortality rate.
What did you do to have such a dramatic improvement in your HSMR results from last year?
We actually did not make any substantial changes to the care we provide or the way we treat our patients. What we did do is review our score from a clinical and administrative perspective and from this we were able to determine that our issue was on the administrative side with how we capture information in patients’ charts. Our clinical review merely reinforced what we already knew; that we were providing safe, high quality care to our patients. We then used this knowledge to educate our staff and physicians about the importance of how we capture information about our patients in their charts. We continue to educate our staff on an ongoing basis.
As an organization, we have always been committed to quality and, as such, have implemented a number of initiatives including intensivists in the ICU, hospitalists and our critical care response team. As well, we have further strengthened our focus on hand hygiene, which we know is one of the most significant factors in helping to reduce infections and the spread of diseases.