“Epsom and St Helier NHS Trust say the intensification of its infection control programme – now not just with alcohol handwashing units at ward entrances but also at the end of each patient’s bed – has brought down its MRSA rate.

“These show the trust had a rate per 1,000 bed days of 0.22 – comparing favourably with results from the period between April and June 2003 when the rate was 0.43 per 1,000 bed days.

“A trust statement said: ‘This shows the second greatest improvement in MRSA bacteraemia rates in the country.’ . . ”
http://icsurreyonline.icnetwork.co.uk/0100news/0700epsomandbanstead/tm_objectid=16399535&method=full&siteid=53340&headline=we-re-beating-mrsa—says-trust-name_page.html#story_continue

But I was quoting a news agency which claimed to be quoting from, “The Scottish Audit of Surgical Mortality”.

I can’t speak for the practices of all British hospitals but I have testified as to my own, very specific experience of a surgical procedure in a London teaching hospital where MRSA swabs were taken before surgery.

What I can also say from following the news and from personal contacts with (mainly retired) health service professionals is that post-surgery MRSA infection is certainly a challenging – and so far largely intractable – continuing issue for hospitals in Britain.

Googling will retrieve huge repositories of news reports, studies, audits, ministerial announcements and the like. The problem has international dimensions – not least because this malignant strain of Staphylococcus aureus is alleged to be deeply entrenched in a particular province of Canada, and with significantly lower infection rates elsewhere in Canada.

This is arguably important because it suggests that a silver bullet approach – eg “it’s all due to poor hospital cleaning” because of private cleaning staff – is unlikely to be viable as an explanation for the incidence of MRSA or the basis of a successful remedy.

In the present context, I am also saying that hospital league tables were challenged on similar grounds to school and local education authority league tables but they have become a valued tool for illuminating (often life-critical) issues in healthcare and professional competence. Whatever their flaws, these tables won’t be pushed back into the bottle.

Btw on school league tables, I have a CD, issued recently as a freebie by The [London] Times, with an all schools database supposedly showing the examination results of each and every school. The protective cover displays in bold type: Parent Power.

Having been through a cardiac [diagnostic] surgical procedure at a major London teaching hospital almost exactly a year ago, I can assure you that some hospitals take precautions against MRSA infection very seriously. In addition to maintaining rigorous cleaning and staff hygiene practices, all surgical patients are routinely subject to swab tests for MRSA infection before surgery.

Fortunately, I had no subsequent MRSA complications – but I was nevertheless much relieved to be advised that as the result of the procedure, the need for further cardiac surgery wasn’t indicated. This contrasts with the previous experience of someone I know well who twice contacted MRSA infections after cardiac surgery at other hospitals. I also know several people who live locally and who lost spouses through MRSA infections following surgery.

The hazards of post-surgery MRSA infection are really not to be under-estimated. I can promise you that it is not just a tabloid scare but a very real issue.

And that’s “infected by” not “killed by”.

Ben Goldacre in tehgrauniad is very good on MRSA testing – apparently some places find it where other places don’t. Like hundreds of times more often. Particularly when contacted by the tabloid press.

What about the other 1500 stiffs? Were their deaths not politically useful to some pressure-group or other?

“LONDON, Dec. 2 (UPI)—One-fifth of post-surgical patients in Scotland were infected by bacteria such as MRSA, a government report said. The Scottish Audit of Surgical Mortality quantified deaths related to hospital superbugs for the first time and said that of 1,854 people who died after an operation, 376 of them were infected by methicillin-resistant Staphylococcus aureus, known as MRSA despite Health Department campaigns to control infections.”
http://www.upi.com/NewsTrack/view.php?StoryID=20051202-021024-2659r

Although I have some sympathy with the argument, it’s clearly wrong in many cases including this one. The obvious response is that, for policy purposes, the performance of the school for a cohort that’s already finished doesn’t matter, except as a signal about likely performance in the future. The only way you can assess the usefulness of the signal is to treat the current cohort as a subset of a larger population, and issues of statistical significance immediately arise.

You can’t be a smoker and effectively lobby for implementing the FTCT, which is an important part of the WHO business.

It would sound like “Hey, I can’t convince myself to quit, but surely some of those 1 billion Chinese will fall for my great anti smoking PR line!”.

We are learning to live with proliferating numbers of league tables for all sorts of things from football teams through “international competitiveness” to the Global 500 and the ranking of hospitals for surgery success and infection rates. Police forces now have to cope with regular performance rankings. The genie is finally out of the bottle and if there aren’t official league tables, the likelihood is that the press will invest resources to build their own league tables for the public services because their readers – the consumers of public services – want to know and won’t be put off.

Hospital league tables generated a parallel critical discussion to education league tables. Challenging issues arise in ranking hospital departments – the major teaching hospitals tend to attract referrals of especially difficult cases with inbuilt risks of higher failure rates so adjustments need to be made for that factor in making comparisons but the league tables illuminated some worryingly high failure rates in some hospital departments which then became the focus of closer investigation and remedial measures where appropriate. It will virtually impossible to coax that genie back into its bottle now.

Much the same applies to local education authority and schools league tables and for similar reasons. For all the many flaws in the tables, there are substantive reasons for continuing concern about raising and sustaining schooling standards in Britain as I have tried to argue and document above.

We need to recognise situations where particular schools are failing in order to focus investigation and introduce remedies. The fact is that many stereotypical explanations are often actually incorrect – I can recall a paradoxical case of an 11-18 (comp) school with miserable attainment rates at GCSE for 16 year-olds but above national average attainment rates at A-level for its small sixth form. How come? There is no obvious, credible explanation in terms of resourcing or poor teaching – I fear the Orwell factor applied.

http://www.mlwin.com/hgpersonal/

This is very difficult stuff.

Bob b: I disagree. The critics of tables believe that they thoroughly mislead, rather than provide useful information. HG has offered numerous criticisms and suggested amendments. Not all have been ignored, but many have. There is no “alternative”; we realsie there will be tables, but we hope that people will look at the information they purport to contain with a good deal of scepticism. We don’t think they are particularly useful levers in school improvement.

Suppose league tables were entirley useless. Why should the person pointing this out be under any more of a burdne than the proponents of the table, to propose an alternative?

Well, the article does say that, even if it didn’t mean it:

so wide that they overlapped those of every other school, making a mockery of any attempt at ranking them

The relative ranking of two schools could easily be 99% certain while their 95% error bars overlapped. Not many things in life are 99% certain, it would be pretty foolish to mock those that are.

In any case, the concept of ‘error bars’ based on sampling error seem pretty dubious – is he really assuming the academic success of pupils in the same class, doing exams on the same day, is statistically independant?

It really does seem to me that either the article simplifies or distorts the professor’s views, or someone is attempting to deliberately mislead through misuse of statistics.

That aside, there is clearly some kind of valid underlying point here, that league tables are more precise and cleaner than the underlying data supports. A school bouncing about between, say, #1 and #3 in a league table almost certainly means nothing in terms of actual standards, but probably causes the head no end of phone calls from irate parents.

Sport aside, not many other areas of life evaluate things so brutally. Kitchen salesmen and japanese school pupils may get ranked strictly, everyone else gets a much vaguer grade, more like the school grades ‘A+’ to ‘F’.

Perhaps some qualified statistician could come up with a scheme where schools with a ranking that was genuinely statistically uncertain were ranked equal in the table?

soru

Critics of the league tables really need to focus on that substantive issue and come up with alternatives. Despite an open invitation, they have conspicuously failed to do so.

I’m not sure how true this is. My central Scottish high school, on the edge of a large town but with a partly rural intake, had approx 300 – 350 pupils per year and I don’t think that was atypical.

Although that would decrease to about 150 per year once all the kids who weren’t doing Highers left.