Cape Breton in-hospital death rate down, but still highest in Canada

Fewer people are dying in Cape Breton hospitals this year compared to last year, but the mortality rate is still the highest in the country, according to new data from the Canadian Institute for Health Information (CIHI).

The hospital standardized mortality ratio measures the number of deaths compared to an expected average. It is standardized to take into account patient age, sex, related medical conditions and more.

"It looks like it is headed in the right direction," said Joseph Amuah, manager of content for CIHI's Your Health System website.

He said the mortality rate is not the only way to measure hospital outcomes.

"This is only one indicator, so it is important to look at the whole picture before drawing a fulsome conclusion," Amuah said.

CIHI measures 10 different outcomes for the Cape Breton health complex — which includes the regional hospital in Sydney and community hospitals in New Waterford, Glace Bay and North Sydney — and many other outcomes are in the normal range, Amuah said.

For example, hospital re-admissions after surgery, the number of hip fracture surgeries performed within 48 hours and hospital deaths following major surgeries are all close to the national average in Cape Breton, he said.

Even though the mortality measure is standardized, Amuah said there are always individual circumstances when it comes to people's health.

"We do take into account the age and the sex and [the presence of two or more chronic diseases or conditions in a patient] and other factors in standardizing the indicators," he said.

"However, we will never be able to take into account every single factor that may affect a patient's health status that may ultimately lead to them passing away."

Amuah would not say if the number of in-hospital deaths in Cape Breton is concerning, though.

"A question like this is best handled by or responded to by the hospital itself, because they actually have a better understanding of the kind of patients that they take care of and what processes they have in place for providing care," he said.

Dr. Ward Patrick, senior director of critical care for the Nova Scotia Health Authority, said the numbers are taken seriously.

"Any time that your [mortality ratio] is elevated, it's obviously not something that you take lightly," he said.

"You're going to take a look at it and you're going to try and do things. We've put nine provincial programs in place [and] will try and standardize care in all of those different areas over the next little while."

Standardized care, better data

In addition, the health authority has methodically checked its charts and its coding practices to ensure more accurate data is sent to CIHI.

Patrick said the public should take some comfort in the fact that health officials have been able to bring the Cape Breton and Nova Scotia numbers down significantly since last year.

"The good news for the people of Cape Breton and Nova Scotia is that we're seeing the turn," he said. "It's actually starting to improve and I'm hopeful that this is the start of a positive trend for years to come."

According to CIHI, the number 100 roughly represents the average expected number of deaths at any given hospital.

A number higher than 100 means more people are dying than expected.

Last year, the ratio for the Cape Breton health complex was 144.

CIHI says the methodology used to calculate the numbers changed between last year and this year, so last year's actual number for Cape Breton translates to 158.

This year, the ratio in Cape Breton is down from 158 to 133.

The data show the national average is now 97.

Provincial ratio higher than national

The overall number for Nova Scotia is 120. The provincial average was 129 last year, so it, too, has gone down, but is still higher than the national average.

This summer, the health authority said it was trying to figure out why so many people are dying in Cape Breton hospitals.

There were errors found in some of the data sent to CIHI last year, but they only accounted for about two per cent of the elevated mortality numbers.

Quality improvement takes time

Patrick said there's no simple answer and it will just take more time to closely examine practices and processes after a patient dies in hospital.

"When you start down a quality improvement pathway like this, you have to remember, it's a process, not an event," he said.

"You're not going to be able to correct everything all at once, but the fact that you're seeing really good improvements in the space of 12 months makes me really optimistic that we're going to see that kind of pattern as time goes on."

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