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What are RAMI, SHMI and HSMR and how they can support learning from deaths?

Across the UK clinicians and hospital leaders need assurance that the number of patients who die in is not higher than would be expected. 

Simply counting the total number of patients who have died does not take account of how ill patients were before coming to hospital, or the nature of the treatments that they undergo while staying in hospital.

Board members, managers and clinicians should use risk adjusted mortality measures as tools to predict the number of patients you would expect to die and ensure that services are providing excellent care and not resulting in unexpected deaths. 

In the UK there are three common measures in use which use historic data and statistical modelling in slightly different ways. 

These are:
RAMI – Risk Adjusted Mortality Index
SHMI – Summary Hospital-level Mortality Indicator
HSMR – Hospital Standardised Mortality Ratio

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