Hospital mortality rate dips slightly

Posted on December 12, 2008 in Governance Debates, Health Debates – Health – Hospital mortality rate dips slightly
December 12, 2008. ANDRÉ PICARD

The mortality rate in Canada’s hospitals dipped slightly over the past year, an indication that it’s a tad safer for patients getting care.

The hospital standardized mortality ratio (HSMR) – a comparison of expected deaths and actual deaths – fell to an average of 96 this year from 100 last year, according to data released yesterday by the Canadian Institute for Health Information.

The number of deaths expected for both the past year and the previous year was 100.

But, behind the overall positive trend, data from individual hospitals show startling variations, from a high of 126 at Cape Breton Healthcare Complex in Sydney, N.S., to a low of 64 at Regina General Hospital.

“What you want to see over time is a convergence toward the middle, but there’s still a lot of variation in the numbers,” said Indra Pulcins, director of indicator and performance measurement at CIHI.

This is only the second year that CIHI has published HSMR data. While the agency cautioned against comparing the rates in individual hospitals, that is precisely what has happened, sometimes with positive results.

At Scarborough General Hospital in Toronto, which last year had one of the worst scores – an HSMR of 129 – the poor showing served as a catalyst for the introduction of patient safety measures.

These included concerted efforts to reduce infections after surgery and cut adverse drug reactions – two of the leading causes of preventable death in hospital patients.

“Unfortunately, sometimes it takes something very dramatic to get people’s attention focused in the right direction,” said Steven Jackson, the hospital’s chief of staff.This year, the hospital’s HSMR improved markedly, to 109.

The data released yesterday include HSMR results from 76 large acute-care hospitals and 41 health regions across the country, with the exception of Quebec.

The measure counts deaths from 65 causes that account for about 80 per cent of in-hospital deaths, including the leading causes: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease and septicemia (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.

The HSMR measure, which was developed in Britain, is used by several countries.

What is unusual about HMSR, however, is that it is a moving target – the ultimate aim is to reduce variations in mortality and overall mortality.

“Actually, we don’t know what the target is because we don’t know how low it can go,” Dr. Pulcins said. “Only time will tell.”

Phil Hassen, CEO of the Canadian Patient Safety Institute, said that while the HMSR is designed to help hospitals and health regions track their progress on safety, it ultimately benefits patients.

“The HSMR is one more tool that can help measure the progress of their efforts in a tangible way and help make health care safer,” he said.

Canadian hospitals had a total of 86,000 deaths during the past year.

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