Friday, November 30, 2007

Study ranks hospital mortality rates.

This report is from the Globe and Mail.Study ranks hospital mortality rates. While such a study is of some use in that some possible problem areas can be identified the factors that cause higher or lower death rates may have little to do with the quality of care at a particular institution.Before getting excited about poor quality care these would need to be examined. If you happen to get more seriously ill and dying patients than the average hospital of course your waits should be higher. The way to improve performance would be to send the worst patients to the hospital next door! Nevertheless the article does point out that many patients die in hospitals who would have lived if procedures were better.

Study ranks hospital mortality rates.
Facilities in New Brunswick, Alberta and Saskatchewan come out on top, boasting some of the lowest numbers

With reports from Avis Favaro, CTV News and The Canadian Press

November 30, 2007

For the first time, a national study has tackled the contentious and provocative issue of death rates in hospitals, listing Canadian institutions by name and revealing where patients are likely dying avoidable deaths.

Though the Canadian Institute for Health Information researchers say the Hospital Standardized Mortality Ratio study should not be used to compare hospitals, it is inevitable.

By province, hospitals in Newfoundland and Labrador and Nova Scotia had some of the highest in-hospital mortality while many hospitals in New Brunswick, Alberta and Saskatchewan boasted some of the lowest.

In Canada's biggest city, the numbers are so dramatic that ailing patients in search of a specialist referral may wish to consider taking the subway downtown to Toronto's University Health Network, which not only sees the sickest patients but also had one of the lowest ratios. The same goes for St. Michael's Hospital, which also had low mortality figures.

The Hospital Standardized Mortality Ratio (HSMR) examines the numbers of expected deaths versus actual deaths in 85 acute-care hospitals at 92 sites across Canada. Of those, eight hospitals had some or all of their results suspended from publication, after hospital officials argued successfully issues of data quality. Other, smaller hospitals are also using the measure but were not included in the published report, due to small patient numbers.

The measure looked at 65 diagnoses that account for 80 per cent of in-hospital deaths including the top five: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease and septicemia, which is blood poisoning.

Data were adjusted for age, gender, urgent versus planned hospital admissions, whether patients were transferred from another hospital, the length of stay and other health problems, to name a few. In making those adjustments, researchers sought to make a level playing field for all hospitals.

Each hospital was graded against the Canadian average, which was assigned an HSMR of 100. A ratio equal to 100 suggests there is no difference between a local mortality rate and the average national death rate. A figure greater than 100 means a higher mortality rate, while below 100 spells a lower mortality rate.

Cape Breton Healthcare Complex in Nova Scotia fared the worst, with the highest overall figure of 137 from 2004-2007. Conversely, Regina General Hospital had the lowest figure - 71 - suggesting far fewer deaths than expected.

Nova Scotia Health Minister Chris d'Entremont conceded yesterday that the numbers are "particularly bad in Cape Breton," but said his ministry needs to look at exactly what the figures mean.

"We don't know if it's quality of care or just the kind of patients we have. Is it an issue with funding? I don't think it's to do with funding. It's to do with the aging and infirmity of the patients we do have."

Yesterday, Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said: "The big thing is to help people understand that there is work to be done. We have adverse events occurring and people are dying, but some of these can be avoided."

Each year, an estimated 23,000 Canadian patients die avoidable deaths in hospital, Mr. Hassen said, relying on figures in a different study. Even that number is conservative, he said, given that 8,000 to 12,000 of those casualties are due solely to hospital-acquired infections.

And yet efforts to reduce injury and death are not a secret to hospitals. Areas where the biggest reductions can be made to whittle down death rates and avoidable injuries include introducing rapid-response teams, ensuring best-practice management of heart attacks and cutting down on medication errors.

Though yesterday was the first public announcement of the HSMR data, it has been used by hospitals since 2004-2005. And since then, it has resulted in a 6-per-cent drop in standardized mortality over the past three years, which translates into 2,500 fewer in-hospital deaths, said Jennifer Zelmer, CIHI's vice-president of research and analysis.

However, researchers cautioned yesterday that the public should not use it as a shopping guide, saying patients with heart attacks or some oth

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