Abstract

Objectives: To compare the effect of a new regime of external inspections of acute trusts performed by the Care Quality Commission (CQC) on rates of adverse events in the English National Health Service (NHS). Design: Interrupted time-series study with control using a mixed-effects random-coefficients multilevel model. Setting: Acute NHS Trusts in England (n=155). Sources of data: Publicly available data on dates and type of inspection, demographic characteristics and financial risk of hospitals from the Care Quality Commission, Monitor, NHS England, and the Trust Development Authority. Interventions: A new regime of external inspections, which is more resource-intensive, comprises intelligent monitoring, and gives ratings to core services. Main outcome measures: Rates of falls with harm and pressure ulcers from April 2012 until January 2016. Results: In the study time period, 65 acute trusts (42% of all English hospitals) were inspected using the new regime and 46 (30%) using the old one. There was a downward trend in adverse events before inspection, of -6.7 falls and – 5.8 pressure ulcers per 10,000 patients/month. The announcement produced an abrupt reduction in the rate of adverse events, but the next month after the inspection there was a non-significant increase in adverse events. After the inspection the rate of decline reduced significantly compared to the pre-inspection period: under the old regime -4.4 falls and -6.8 pressure ulcers per 100,000 patients/month; new regime -3.8 falls and -5.7 pressure ulcers per 100,000 patients/month. Conclusions: Neither external inspection regimes had a positive, clinically relevant effect on adverse event rates. Under both regimes, the downward trend before the announcement was reduced after the inspection, with the new regime having a less detrimental effect. Future research should focus on other measures of process of care and outcomes such as mortality, and actual underlying processes causing stagnation of downward trends. The estimation of costs associated with the inspection could shed light on the cost-effectiveness of this intervention.