Hospital death rate dropping, report shows

Canadian hospitals are improving the chances that patients will survive, new statistics suggest. The hospital standardized mortality ratio (HSMR) data released by the Canadian Institute of Health Information (CIHI) shows that nationally, the rate of in-hospital deaths has fallen four per cent over the past year, said Dr. Indra Pulcins, director of indicator and performance measurement at the group. While the data shows some hospitals and health regions have made progress in cutting patient mortality, there are variations by hospital and region. Nonetheless, the trend is down. "The bar gets lower every day," Pulcins said. Among the 76 large acute-care hospitals or hospital corporations across Canada (excluding Quebec, where the data is collected differently), 47 reported drops, two were unchanged and 25 reported increases. CIHI says the data should not be used to compare hospitals because of the different factors involved, but "provides an important starting point for hospitals and health regions to assess their mortality rates and identify areas for improvement." But even hospitals that are below the national average of can improve, Pulcins said. And CIHI would also like the variation between hospitals and health regions to drop. Hospital mortality ratio The hospital standardized mortality ratio is a statistic showing the number of deaths that occurred in a hospital or health region divided by the number of deaths expected, times 100. An HSMR greater than 100 suggests that the hospital or region's mortality rate is higher than the national average; under 100, that it is lower. The HSMR focuses on the people with ailments that account for the majority of in-hospital deaths. It's adjusted to take age, sex, length of stay, admission category, diagnosis and other factors into account. CIHI cited Ontario's Scarborough General Hospital in the Greater Toronto Area as a success story. The HSMR declined from 125 in 2005-06 to 109 in 2007-08. A number over 100 suggests that the hospital has a mortality rate over the national average. Scarborough General adopted "a culture of patient safety" — including cutting adverse drug reactions and surgical infections — after the first public release of HSMR data last year, CIHI said in a news release Thursday. "Unfortunately, sometimes it takes something very dramatic to get people's attention focused in the right direction," Dr. Steven Jackson, chief of staff at the hospital, said in the release. There are still things the hospital can do better, "but the HSMR initiative has helped motivate people to take this on." It's not just mortality rates that can be improved, Pulcins said. "A number of years ago, it was thought impossible to prevent pneumonia" among patients on respirators, but now some hospitals go for months without a case. HSMR rates for some urban areas, 2007-08 and 2004-05 Health region No. of hospitals/corporations Rate '07-'08 Rate '04-'05 Vancouver 10 83 98 Calgary 11 88 87 Winnipeg 7 105 115 Toronto 6 97 96 Halifax 6 93 125 St. John's 8 102 114 Source: CIHI