Ontario hospitals lag other provinces in six key clinical areas, including higher rates of caesarean-section births and more readmissions of patients after surgery, according to a comprehensive report on the performance of more than 600 Canadian hospitals.
The Canadian Institute for Health Information (CIHI) posted the updated figures to its website Wednesday. The database tracks 21 clinical performance measures.
“We are in a world of continuous quality improvement,” Ontario Health Minister Deb Matthews said, noting executive compensation is now tied to performance quality.
Ontario ranked slightly better than the national average in readmissions to hospital after knee replacements, in-hospital hip fractures for the elderly, obstetrical trauma during delivery and obstetrical readmission rates.
Kira Leeb, CIHI’s director of health system performance, said the data show Ontario is “going in the wrong direction” in a number of other statistically significant areas.
Provincial hospitals are reporting too many caesarean sections, too few vaginal births after C-sections, frequent readmissions for patients 19 years and younger, elevated readmission rates for surgical patients and a high number of medical and surgical patients who become more ill or injured while in acute care — a phenomenon captured in a category called “nursing-sensitive adverse events.”
William Osler Health System, which includes Brampton Civic, Etobicoke General and Peel Memorial hospitals, reported a rate of 33.65 C-sections per 100 births — the highest for large community hospitals in the Toronto region. The national average is 27.
Humber River Hospital ranked worst in Canada among large community hospitals for performing too few vaginal births in women who have already delivered by C-section.
“We actually want to see more vaginal births after C-sections,” Leeb says, noting a shift in birthing strategy. Humber River performs only 4.74 vaginal births after C-sections for every 100 births, compared to 17.69 nationally.
Humber River spokesman Gerard Power said the construction of a new hospital site should help address the problem.
Of teaching hospitals in the GTA, St. Michael’s in downtown Toronto has the longest way to go in improving its rate of vaginal births after c-section. For every 100 deliveries there, nearly 11 are c-sections following a vaginal birth. The average rate for similar hospitals is 22.74.
Hospital spokesperson Leslie Shepherd said the result may have to do with the large population of immigrants from under-privileged backgrounds that St. Mike’s serves.
“Sometimes, they have had minimal prenatal care or come late into care. This makes them at higher risk of developing problems in labour and delivery which often result in Caesarean section,” she said.
Lakeridge Health, in Durham region, had the highest number of “nursing-sensitive adverse events” in the province. For every 1,000 surgical patients at Lakeridge, 53 ended up with urinary tract infections, pressure ulcers, in-hospital fractures and pneumonia, compared to 36 nationally.
“We set ourselves a target to become the safest hospital,” Lakeridge president Kevin Empey said. He expects the progress to be reflected in next year’s CIHI report.
To reduce in-hospital fractures, Lakeridge has purchased special beds that can be lowered to the ground and places purple arm bands on patients prone to falls. To reduce pressure ulcers, it has purchased special mattresses with air pockets for patients who stay in bed for long periods.
They are also ensuring these patients are rolled onto their sides and mobilized more. To reduce cases of pneumonia, Lakeridge has adopted a new protocol for patients on ventilators who are prone to getting the condition. In fact, the hospital corporation has come close to eradicating the problem of ventilator-acquired pneumonia.
Empey pointed out that the report also highlights where Lakeridge stacks up well. For example it performs above the national average on readmission rates following hip and knee replacement surgery.
Toronto East General Hospital and North York General were among three large community hospitals singled out by CIHI for their low rates of in-hospital deaths within 30 days among patients admitted for a heart attack.
Both hospitals scored “significantly below” the Canadian average for hospitals of the same size. Toronto East General had a death rate of only 2.97 per cent and North York General had a death rate of only 3.38 per cent. The national average for hospitals of the same size was 7.07 per cent.
“We are, in fact, always looking at this data and always trying to improve it, whether we are above average, below average or on the average,” said Toronto East General president Rob Devitt.
Pat Campbell, president of the Ontario Hospital Association, noted that patients in this province tend to be sicker, making cross-country comparisons difficult.
“It is generally not an apples-to-apples when you look at these statistics,” she said.
Ontario hospitals are “more efficient” than those in other provinces because lengths of stay are shorter and admission rates are lower, Campbell added. More patients are cared for outside of hospital, in their own homes, by primary care providers and community health-care workers.
CIHI’s Leeb said institute is working on making the database more user-friendly and plans to launch an improved version next year.
Data analysis by Andrew Bailey0