Revealed: Mortality rate of every NSW hospital
What are your chances of dying if you go to hospital after a heart attack, a stroke, or even an operation to fix a broken hip?
Surprisingly, this can vary markedly depending on what hospital you are taken to.
Health boffins have begun measuring this mortality rate in an effort to see how care can be improved - particularly after patients are discharged.
The NSW Bureau of Health Information (BHI) has created a "30-day mortality ratio" of seven common conditions such as strokes, pneumonia and heart problems, which account for 11 per cent of acute hospitalisations.
The ratio they use, a figure just under or over 1, takes into account the volume of patients treated at a particular hospital and key risk factors beyond the control of the hospital, such as old or young patients in nearby suburbs.
Above the figure of one is a worse outcome than expected and below one is a result better than predicted.
If you have a heart attack and go to hospital, the raw figures show your chance of dying 30 days later is 5.9 per cent. But at the Blue Mountains Hospital, this crude death rate is 12.9 per cent after 30 days. Using the BHI's mortality ratio, the hospital scored 2.5, indicating "mortality is higher than expected".
By comparison, the death rate 30 days after a heart attack at Fairfield Hospital is 2.7 per cent, with a ratio score (taking into account their patient mix), of 0.65 per cent, indicating "lower than expected" deaths.
Other hospitals with comparatively higher heart attack deaths include Nepean and Port Macquarie, but better rates were found at Blacktown, Prince of Wales and Royal North Shore hospitals.
St Vincent's in Darlinghurst had lower than expected deaths from haemorrhagic stroke, pneumonia, congestive heart failure and chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease - a type of lung disease - outcomes were better at Royal North Shore, Prince of Wales and Royal Prince Alfred.
Ryde was good for hip fracture surgery and congestive heart failure.
However, at Bowral Hospital, the outcomes were "worse than expected" for congestive heart failure with a ratio of 1.45 and hip surgery with a 2.67 ratio.
Ischaemic strokes - caused when a blood clot stops blood flow to the brain - had worse outcomes at Broken Hill, Nepean, Tamworth and Westmead.
Haemorrhagic strokes, where an artery bleeds into the brain, had worse outcomes at Campbelltown and Wyong and better outcomes at Prince of Wales and St Vincent's.
Bowral also scored poorly on its survival rate after hip fracture surgery, with a 15.1 per cent death rate after 30 days, compared to the raw state average of 6.4 per cent. The NSW Bureau of Health Information publishes both the raw and ratio data but doesn't like comparisons being made using the raw mortality figures.
"It's useful information, principally for hospitals and clinicians," the bureau says. "However, in reporting on mortality performance, we apply 'risk adjustment' to take into account these factors and to create a measure… that is fair, meaningful and useful for informing improvement comparisons."
Medical Error Group founder Lorraine Long says the figures are a powerful insight into how a hospital performs.
"Sometimes there's a rush to discharge patients, and no care afterwards," she says. "These figures give it away."
Ms Long says she's also been keeping an eye on Dubbo Base Hospital's death rate after hip fracture surgery. It stands at 7.6 per cent mortality, and its patient adjusted ratio is 1.45.
She points to the case of Alan Wells, 85, who died on November 10 2019 after hip surgery - "discharged too quickly when he couldn't walk and was clearly very unwell".
Ms Long says his family were forced to beg nurses not to discharge him to a private hospital and he was "grudgingly" allowed to stay a second night, but less than 24 hours after a second surgery he had a heart attack and was put on life support.
He was then diagnosed with deep vein thrombosis in both legs and a pulmonary embolism after his anti-clotting medication was stopped.
"He was an independent and kind man who never complained," son Darran Wells said. "We can't understand why the hospitals wouldn't let him stay."
The hospital disputes some of the allegations and Health Minister Brad Hazzard has asked for a review.
In another case, retiree Tony Felgate woke up with a headache in the night last November and took Panadol.
In the morning he had a numb arm, but thought he must have slept on it. Later in the day Mr Felgate, 80, from Lurnea, noticed a weakness in a leg, told his wife Mary, 78, and she says the alarm bells went off in her head.
She rang an ambulance, and he was rushed to Liverpool Hospital, which has a survival ratio for stroke of under one, but a CT scan didn't show a stroke. Doctors wanted a definitive MRI scan to be done that afternoon. But it didn't get done and staff told him he now had to wait until Monday morning.
When it was finally carried out it revealed he'd suffered three ministrokes and Mr Felgate is now waiting for a procedure in March to put in a heart implant.
"People just don't get sick on weekdays," Mr Felgate said.
A lack of radiology was raised by senior doctors as one of several serious issues that need to be rectified, at a parliamentary hearing last year.
Originally published as NSW hospitals: Where you have the best shot at survival