What actually happens if a hospital’s survival rate is below its predicted range?

The national audit body works with the hospital to check the quality of the data. If this is fine, the hospital and the relevant national health service explore the processes of care at that hospital. If these bring to light any concerns, the health service and the hospital work together to improve care, which might include temporarily suspending heart surgery at that centre.

If a hospital’s survival rate is below its predicted range (either the main or extended predicted range), everyone wants to be sure that there is not a potential problem in the pathway of care. It is important to either rule this out or start to improve care if it’s decided that this is the reason. (See also What does it mean if a hospital is outside its predicted range?).

If a hospital's survival rate is below the predicted range, the National Congenital Heart Disease Audit Steering Committee is notified. The Committee in turn notifies the relevant national health service’s Medical Director and the lead doctor for congenital heart disease at that hospital and a detailed examination of the hospital’s results takes place. There are established and published procedures which can be put into action if the detailed assessment raises concerns about care. In England, for instance, this would involve the British Congenital Cardiac Association and/or the Care Quality Commission.

There are two main steps:

Step 1

The hospital is asked to recheck the data it submitted for any errors.

Step 2

With the corrected data:

If the hospital’s survival rate is still below its predicted range but within the extended predicted range (like this ), then an internal hospital review is conducted to understand whether there is cause for concern.

If the hospital’s survival rate is below the extended predicted range (like this ), then an external review of the hospital’s processes and results would be instigated.

In all such cases, the reviews (whether internal or external) would be published online by NCHDA at the same time as the Annual Report.

NOTE: It is quite common for one of the 13 hospitals to be outside its predicted range, but it is rare for any of them to be outside the extended predicted range. (See also: Looking at ALL hospitals)

The NCHDA also publishes additional reports from any hospital which has a survival rate below its predicted range. These are available here, along with the NCHDA annual reports.

Survival rate
The percentage of operations where the child survived at least 30 days after their operation.
Predicted and Extended Predicted range:

We expect a hospital's overall survival rate to lie within its predicted range 19 times out of 20.

We expect a hospital's overall survival rate to lie within its extended predicted range 998 times out of 1000.

An illustration of how we present a hospital's survival rate (black dot) in the context of its predicted range (dark blue bar) and extended prediction range (light blue bar) is given below: