Hospitals making progress in reducing deaths

Canadian hospitals are making progress in reducing hospital death rates, a new report indicates, but certain orthopedic surgeries and some other procedures are being done when they may not be needed.

TORONTO — Canadian hospitals are making progress in reducing hospital death rates, a new report indicates, but certain orthopedic surgeries and some other procedures are being done when they may not be needed.

Forty per cent of 75 hospitals reporting had significant declines in their ratios of observed deaths to expected deaths, the Canadian Institute for Health Information said in its annual report released Thursday.

“Overall this is really positive news from our perspective in terms of the quality and safety, which is what HSMR (hospital standardized mortality ratio), that big dot indicator, attempts to capture,” said institute president and CEO John Wright.

He said patients and taxpayers should be taking a look at the indicators for hospitals in their communities and ask tough questions if improvements aren’t being made.

The indicators, which have been compiled since 2007, have triggered action in some hospitals, he noted.

“There’s a facility in Newmarket, Ont., that took a look at why is their HSMR where it is, and they found a situation with sepsis (an infection), and they took significant steps to address that,” he noted.

In terms of individual procedures, the report found that more than 3,600 therapeutic knee arthroscopies were done in 2008-2009 despite growing evidence that they don’t improve outcomes or reduce discomfort when used to treat osteoarthritis.

“In some cases, simple physiotherapy or other forms and less expensive forms of treatment may be just as good if not better,” Wright said.

“Each one of these surgeries costs roughly $1,200, and we’ve got very high rates of these surgeries in P.E.I., Nova Scotia and New Brunswick.”

And 1,050 vertebroplasty procedures were done on patients with vertebral fractures associated with osteoporosis, even though evidence suggests those who have it done fare no differently than those who undergo placebo procedures.

“Why it caught our eye is the number of these surgeries, albeit small, seems to be climbing and not going down,” Wright observed.

“So we had about 600 in 2006 and now we’re up to a little over a thousand in 2008-09. And again, we’re saying, why is this?”

There were also wide regional variations in C-section rates — ranging from 14 per cent of first deliveries in Manitoba to 23 per cent in Newfoundland and Labrador.

Wright said an analysis showed that if the whole country had C-section rates like Manitoba’s, the system could save roughly $36 million.

And although hysterectomies — operations to remove all or part of the uterus — are declining, there are wide variations across the country, the report showed.

They ranged from a high of 512 per 100,000 women in P.E.I. to a low of 185 per 100,000 in Nunavut.

Other highlights of the report:

• On any given day in 2008-09, about 7,550 beds in acute care hospitals were occupied by patients waiting for a transfer to a more appropriate setting, such as a nursing home or rehabilitation facility.

• Between 2004-05 and 2008-09, the age-adjusted rate of hospitalization for new heart attacks dropped from 239 per 100,000 people to 217 per 100,000 people.