Posted on December - 09 - 2011
Study finds ‘massive’ drop in hospital deaths
Fewer Canadians are dying after being admitted to hospital, according to a new study comparing death rates across the nation’s hospitals.
Data compiled by the Canadian Institute for Health Information shows that just over half — 53 per cent — of Canadian hospitals have experienced a significant drop in their mortality ratios since the organization began tracking results seven years ago.
The “hospital standardized mortality ratio,” or HSMR, is a ratio of the actual number of in-hospital deaths in a region or hospital compared to the number that would have been expected, based on the national average and the types of patients a hospital sees.
A ratio equal to 100 means there is no difference between a local mortality rate and the average national experience, given the types of patients cared for.
A number greater or less than 100 suggests a hospital’s death rate is higher or lower than the national experience.
Overall, mortality ratios decreased significantly for more than 10 per cent of acute care hospitals in 2010-2011 over the previous year, the study shows.
“We’re continuing to see a decrease in the overall HSMR scores,” said Kira Leeb, director of health system performance at CIHI.
“This continues to be a good news story. There are almost no facilities that have higher HSMRs” since CIHI started tracking the numbers in 2004-2005, Leeb said.
“It shows lots of progress in paying attention to mortality in hospitals.”
The Top 5 causes of death in hospital are heart failure, chronic obstructive pulmonary disease, pneumonia, acute heart attack and sepsis — overwhelming bloodstream infections.
Other diagnoses accounting for the highest numbers of in-hospital deaths include bacterial intestinal infections, cancers, cardiac arrest, heart failure, kidney failure, stroke and procedure-related complications.
The new report included 75 large acute-care hospitals across Canada, excluding Quebec, which until recently collected and recorded its data in a different way.
A central Newfoundland regional health authority consisting of nine hospitals had the highest ratio, at 120, followed by Cape Breton health care Complex (116) and Sudbury Regional Hospital at 112.
“But those numbers are probably even low compared to what we saw in our first few years” of tracking, Leeb said. The Cape Breton hospital, for example, had a mortality ratio of 143 in 2004-2005.
The Sudbury hospital — now called Health Sciences North — is the main referral hospital for all of northeastern Ontario, where, historically, rates of serious diseases such as diabetes, heart disease, lung disease and certain cancers are higher than the provincial average, hospital spokesman Dan Lessard said in an email.
“Approximately 36 per cent of all the deaths in this period of review involved patients who transferred in to HSN from other parts of the northeast,” he said. That could be affecting the hospital’s mortality ratio, which is under review.
“We are committed to being publicly transparent and accountable with regards to the quality of our services,” Lessard said, adding that the hospital has implemented a number of measures to improve patient safety.
Hospitals with the lowest mortality ratios were Saint John Regional Hospital (62), Edmonton’s Royal Alexandra Hospital (66) and Brant Community Health Care System — Brantford General site, Brantford, Ont. (66).
Overall, Ontario hospitals scored between 66 and 112. Other Ontario hospitals with low mortality ratios included the Windsor Regional Hospital (81), Kitchener’s St. Mary’s General Hospital (69), the Greater Toronto area’s Markham Stouffville Hospital (71) and William Osler Health Centre (72), Thunder Bay Regional Health Sciences Centre (72) and St. Michael’s Hospital in Toronto (76).
In Ottawa, The Ottawa Hospital had a mortality ratio of 91 while the Queensway-Carleton Hospital had an overall ratio of 90.
Hospitals and health authorities in British Columbia ranged from 69 to 103, while Alberta scored from 66 to 109.
Saskatchewan had in-hospital mortality ratios ranging from 67 to 94.
“We’re not at zero per cent and I’m not sure if we would ever get there. That would be the ideal,” said Pamela Fralick, president and CEO of the Canadian health care Association, a federation of provincial and territorial hospital and health organizations.
“But we’ve made massive progress and we just have to keep building on it.”
Hospital mortality rates began to be collected around the time of SARS — a public health emergency that illustrated just how rapidly communicable diseases can spread in hospitals and that heightened awareness around infection control measures as basic as hand-washing, Fralick said.
It was also when the 10-year, federal-provincial health accord was signed, “so more resources were being put back into the health system that had been taken out throughout the 90s,” she said.
Surgical checklists are also being implemented across the country. Like pilots before take-off, surgeons, nurses and anesthesiologists go through a core set of safety checks before operating — is this the right patient, for example, has the surgical site been marked, have the instruments, swabs and sponges been counted?
Checklists “have proven to be hugely effective in reducing adverse events,” Fralick said.
While half of hospitals saw their mortality ratios drop by an average of 16 to 17 per cent over the past seven years, death rates have remained about the same for 44 per cent of hospitals and have significantly increased for three per cent of hospitals.
“It tells us we’ve got more work to do,” Fralick said.
The Canadian Adverse Events Study published in 2004 suggested that, of the almost 2.5 million annual hospital admissions in Canada, about 185,000 are associated with an adverse event — meaning an unintended injury or complication resulting in a prolonged hospital stay, disability or death.
Close to 70,000 are potentially preventable.
That study’s lead author, Ross Baker, said hospital mortality ratios aren’t a perfect reflection of what’s going on in hospitals.
“But I think it’s an important signal — particularly for places that are not improving or, in fact, are getting worse,” said Baker, a professor in the department of health policy, management and evaluation at the University of Toronto.
Hospital-acquired infections continue to be a concern, he said, and as care becomes more complex and invasive, “it raises the risk that things can go wrong.”
skirkey@postmedia.com
Twitter.com/sharon_kirkey
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