April 8th, 2012
WATERLOO REGION — Patients are generally suffering fewer complications after discharge from local hospitals than the Canadian average, according to a new national report.
The Canadian Institute for Health Information’s data, released earlier this week, measures hospitals on 30 indicators of care and finances, including unplanned re-admission rates within 30 days of discharge for a variety of patients.
Reducing readmissions starts with good care and planning in hospital, said Sandra Hett, St. Mary’s vice-president of patient services and chief nursing executive, but also depends on good support when patients go home.
“It’s really trying to link people with follow-up in the community,” Hett said.
Waterloo Region developed a wide array of services from specialty health programs to partner agencies providing care to help people recover and avoid returning to the hospital, she said.
“It is the system that’s really contributing to that success,” agreed Cambridge Memorial Hospital’s president Patrick Gaskin.
Overall unplanned readmission rate per 100 patients in 2009/10 is lowest at Cambridge Memorial at 6.76, compared to the national average of 8.4. St. Mary’s is 7.25 and Grand River is 7.65. Obstetric, pediatric, adult surgical and adult medical patients are included in the overall rate, and in some of those areas local hospitals did far better than average.
Pediatric readmission at Cambridge Memorial is 2.84 and 4.7 at Grand River, compared to the average of 6.24.
Surgical readmission is better at all three — 4.93 at Cambridge, 5.68 at St. Mary’s when the average is 6.5.
Deaths within five days of major surgery are lower than the Canadian average at Grand River and Cambridge Memorial hospitals while St. Mary’s General Hospital is slightly above.
St. Mary’s does have a lower than average mortality rate for heart attack patients in-hospital within a month — 5.65 compared to 7.6 nationally. The Kitchener hospital is home to the regional cardiac care centre and has equipment such as a catheterization lab that all area hospitals use, which is why its rate of angiograms for heart attack patients is higher than average.
“We know that contributes to our lower mortality rate as well,” Hett said.
Re-admission within 28 days after stroke is lower than average at Grand River Hospital, the district stroke centre.
Grand River officials were unable to comment as the hospital deals with decontamination needed in its laboratory after the accidental release of illness-causing bacteria Monday morning. The lab remains closed indefinitely as they consult with experts on how to proceed with decontamination.
Local hospitals vary on nursing-sensitive adverse events, which include urinary tract infections, pressure ulcers, in-hospital fractures and pneumonia and measured for both surgical and medical patients.
St. Mary’s is quite low for medical patients but higher for surgical, which Hett contributes to the complexity of surgeries done at the hospital.
Cambridge is higher among surgical as well, although Gaskin cautioned that the confidence range for their numbers is quite wide. Recently the Cambridge hospital started a new education program on fall prevention.
“That is a major area where adverse events can happen for patients,” Gaskin said.
Both hospitals said they will closely examine the extensive data to see where there are opportunities for improvement in care.
Finances were also part of the study.
Spending on each case at the region’s three hospitals is about the national average of $5,168, with St. Mary’s the lowest and Grand River the highest.
St. Mary’s has the lowest administration expenses of all the area hospitals, measured as a percentage of total costs, at 4.8 just slightly below the Canadian average. Next is Grand River at 5.51 and then Cambridge at 7.17.
Hett said St. Mary’s has a long tradition of low administration costs.
“There’s a value and a strong belief in putting as much resources as we can into patient care,” she said.
Cambridge’s expenses rose over recent years and are above average for peers and nationally, while Grand River’s are steady in recent years.
Gaskin said the latest financial numbers are for 2009/10, the year when Cambridge implemented a new hospital improvement plan after years of struggling with a deficit. Changes included cutting administration positions to lower those expenses.
“It may take a little bit of time, but I’m hoping to see that shift,” said Gaskin, adding that he took comfort in seeing the cost per case is in line with other hospitals.
Hett is proud with St. Mary’s overall good results, saying it shows they’ve invested in the right areas.
“It just reinforces we’ve made some really good choices.”
Johanna Weidner, Waterloo Region Record