Variability in COVID-19 In-Hospital Mortality Rates between National Health Service Trusts and Regions in England: A National Observational Study for the Getting It Right First Time Programme

Background: A key first step in optimising COVID-19 patient outcomes during future case-surges, is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020. Methods: This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, 30 days emergency hospital readmission, length of stay and mortality within 30 days of discharge were also investigated. Logistic regression was used to adjust for covariates. Findings: There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in mortality rates between hospital trusts and regions was relatively modest. Trusts with a larger baseline number of beds had better outcomes than those with a smaller number of beds. Interpretation: There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare for future hospital management of COVID-19 patients during future case-surges. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: Consent from individuals involved in this study was not required. The analysis and presentation of data follows current NHS Digital guidance for the use of HES data for research purposes and is anonymised to the level required by ISB1523 Anonymisation Standard for Publishing Health and Social Care Data.