Hospital Standardised Mortality Ratios
July 2023 to June 2024

About this release

This release by Public Health Scotland (PHS) provides information on Hospital Standardised Mortality Ratios (HSMRs) for the period July 2019 to June 2024. These statistics are updated on a quarterly basis and reflect the HSMR for the latest 12-month reporting period, whilst crude mortality data is presented by quarter and month to show trends.

Main points

• For the period July 2023 to June 2024 no hospitals had a significantly higher standardised mortality ratio than the national average.
• For the period July 2023 to June 2024 no hospitals had a significantly lower standardised mortality ratio than the national average. There were two with a standardised mortality ratio below the lower warning limit: Raigmore Hospital (0.82), Western General Hospital (0.79).

This chart shows each hospitals HSMR for the latest 12 month period plotted on a funnel plot.

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HSMR for deaths within 30-days of admission, July 2023 to June 2024 ^p

Background

Hospital mortality measures have an important role to play in stimulating reflection on the quality and safety of patient care. HSMRs are based on all acute inpatient and day case patients admitted to all specialties in hospital (apart from obstetrics and psychiatry which are excluded). The calculation takes account of patients who died within 30 days from admission and includes deaths that occurred in the community as well as those occurring in hospitals.

The Scottish HSMR is 1.00. If an HSMR value for a hospital is less than one, this means the number of deaths within 30 days of admission for this hospital is fewer than predicted. If an HSMR value for a hospital is greater than one, this means the number of deaths within 30 days for this hospital is more than predicted. If the number of deaths is more than predicted this does not necessarily mean that these were avoidable deaths (i.e. that they should not have happened), or that they were unexpected, or were attributable to failings in the quality of care.

The mix of patients seen varies between hospitals, and the mortality rate may be higher or lower at a hospital for many reasons; the patients seen, for example, may be more seriously ill than average. HSMRs therefore take account of some of the factors known to affect the risk of death, so that comparisons between individual hospitals and Scotland are made on a comparable basis. 

The methodology has been updated to ensure the diagnosis ICD-10 codes for COVID-19, U07.1 to U07.7, are included in the model. These codes were added to capture the high volume of hospital admissions and mortality associated with COVID-19 patients. While we considered including them in an existing group, testing showed that the model fit improved slightly with a separate grouping, which also allows us to isolate COVID-19 cases for future analysis. For more information please refer to the HSMR COVID-19 Methodology Update paper. During the pandemic hospitals have had to adjust their normal ways of working to react to this healthcare emergency. As a result, there will be changes in the volumes of activity in some of the groups used to calculate the HSMRs, for example fewer elective admissions. Any changes in crude mortality trends and HSMRs should be considered in this context.

Further information

A technical document is available on how HSMR is calculated. A frequently asked questions document is also available. For more information see the HSMR section of our website. HSMRs published from August 2019 onwards cannot be compared to prior releases using a different methodology. For more information see Research and Development.

The next release of this publication will be 11 Febuary 2025.