Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance


in-hospital mortality
Al Farabi hospital
Quality care

How to Cite

Bisbis B, El Gamri A. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance. Integr J Med Sci [Internet]. 2016Jan.30 [cited 2020Oct.30];3(1):6-. Available from:


The in-hospital mortality (MIH) is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity), and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, ...). The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.


Lilford R, Pronovost P. Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away. BMJ. 2010;340:c2016.

Pitches DW, Mohammed MA, Lilford RJ. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature. BMC Health Serv Res 2007;20:91.

Girling AJ, Hofer TP, Wu J, et al. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study. BMJ Qual Saf2012;21:1052-6

Raleigh V. SHMI, the new indicator for measuring hospital mortality: more light or more confusion? The king’s Fund – Ideas that change health care. 2011.

New Jersy Hospital Performance Report. Understanding and using Inpatient quality Indicators (IQIs). 2012.

Chiolero A, Paccaud F, Fornerod L. Comment faire de la surveillance sanitaire? L’exemple de l’Observatoire valaisan de la santé en Suisse. Santé Publique. 2014;26(1):75–84.

Luthi JC, Troillet N, Burnand B. Précautions et limitations lors de l’utilisation de la mortalité intra hospitalière comme indicateur de la qualité des soins. Revue médicale de la Suisse Romande 2004;124:697–700.

Goodacre S, Campbell M. What do hospital mortality rates tell us about quality of care? Emerg Med J 2015; 32:244-247

Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals—the Hospital Quality Alliance program. N Engl J Med 2005;353:265-74.

Wilson B, Thornton JG, Hewison J, Lilford RJ, Watt I, Braunholtz D. The Leeds University Maternity Audit Project. Int J Qual Health Care2002;14:175-81.

Hogan H, Healey F, Neale G, et al. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf 2012; 21:737-45.

Hofer TP, Hayward RA. Identifying poor-quality hospitals - Can hospital mortality rates detect quality problems for medical diagnoses? Medical Care 1996; 34: 8: 737-753

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2016 Badia Bisbis and Abdelhai El Gamri