Nova Scotia

Officials working to reduce number of hospital deaths in Cape Breton

Officials with the Nova Scotia Health Authority say they don't know why the number of people dying unexpectedly in Cape Breton Regional Municipality hospitals is the highest in the country, but they're working on it.

Nova Scotia Health Authority still doesn't know why hospital mortality rate is highest in the country

Dr. Mark Taylor, executive medical director for the central zone, says hospitals are constantly improving care and the hope is that will improve the hospital standardized mortality ratio. (CBC)

The Nova Scotia Health Authority says it's still trying to figure out why so many people are dying in Cape Breton Regional Municipality hospitals.

In December, the central hospital in Sydney and three smaller community hospitals combined were found to have the highest mortality rate in the country.

According to the Canadian Institute for Health Information (CIHI), the rate across the province was also above average.

Bethany McCormick, senior director of planning, performance and accountability with the provincial health authority, said eight months after the numbers were published, officials are still going back over the data and making changes to try to improve hospital care.

"It does seem like it's been quite a bit of time, but we wanted to make sure that we were taking a provincial approach to the review," she said.

What the number means

The hospital standardized mortality ratio (HSMR) compares the number of deaths in a hospital to the average expected.

According to CIHI, the number 100 represents the average number of expected deaths. Anything over that means more people are dying than expected.

Last year, Nova Scotia's rate was 117 and the Cape Breton hospital complex was 144, while the national average was just 89.

The Nova Scotia Health Authority is still trying to figure out why Cape Breton in-hospital deaths are higher than anywhere else in Canada. (Tom Ayers/CBC)

McCormick said officials have reviewed patient charts and found a number of errors.

For example, she said, four out of 173 charts belonged to palliative patients who were expected to die and shouldn't have been included in the data sent to CIHI.

However, that only represents about two per cent of the total, said McCormick, and it was only one factor that affected the final number.

"Because we're not able to recalculate the HSMR number specifically, and there's a number of factors that go into that calculation, it's difficult at this time to know whether or not that would have had an impact that would have been a significant result on that number," she said.

Officials say four out of 173 charts belonged to palliative patients who were expected to die and shouldn't have been included in the data for Cape Breton. (Shutterstock)

Dr. Mark Taylor, executive medical director with the health authority's central zone, said improvements in care are always being made, so it would be difficult to determine whether changes resulting from the mortality rate review will lower the number in the future.

"We are constantly improving care based on the best available evidence, and the hope is that ultimately this will impact on the HSMR, but the goal is not to improve the HSMR," he said.

"The goal is to improve our patient care."

The next set of national numbers will be released in December, but Taylor said it's too soon to say whether the Nova Scotia and Cape Breton rates will be lower.

Even if they are lower, health care is complex and it can take a long time to change the number, he said.

"I would not expect a dramatic change," Taylor said.

Chris Power, CEO of the Canadian Patient Safety Institute, said people shouldn't worry too much about the actual number.

She said the rate is mostly a warning flag for administrators.

Chris Power, CEO of the Canadian Patient Safety Institute, says the health authority is taking the right approach by diving deep to understand the problem. (Canadian Patient Safety Institute)

"I wouldn't say that you should be concerned," said Power, who also trained as a nurse and was CEO of the former Capital District Health Authority in Halifax.

"I think you need to understand first why you are the highest in the country."

Power said the health authority is taking the right approach.

"If it's high, you should not so much be worried that your care isn't great ... but you need to understand why it is higher than other similar organizations in the country, and do something about it to start to bring it down."

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ABOUT THE AUTHOR

Tom Ayers

Reporter/Editor

Tom Ayers has been a reporter and editor for more than 30 years. He has spent the last 16 years covering Cape Breton and Nova Scotia stories. You can reach him at tom.ayers@cbc.ca.

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