Health Data Has UHNBC Looking to Make Improvements
Wednesday, April 11, 2012 @ 3:58 AM
Prince George, B.C.- The University Hospital of Northern B.C. is pulling the detail on cases which lead that hospital to be cited as having a very high mortality rate among patients who had undergone major surgery.
The data is part of a report compiled by the Canadian Institute for Health Information (CIHI). The data notes the mortality rate among UHNBC patients within 5 days of having major surgery was 16.5 per thousand. That compares to 2.2 per thousand among the same type of patient at the Concordia Hospital in Winnipeg. The data is available on the CIHI website ( www.cihi.ca ) and is part of a report which rates hospitals across the country . Six of the 15 large hospitals in B.C. (including UHNBC) were rated as performing below the provincial average in several areas.
UHNBC Chief Operating Officer, Michael McMillan, says the mortality stat may also be a reflection of the general health of the population in the region “Northern populations have higher rates of illness, higher burden of illness and in northern B.C. we have a 20% higher burden of illness than populations in any other part of the province. So higher rates of illness can actually translate into different outcomes. Now we’re looking at trying to determine exactly what that impact is, whether that’s a measurable impact for us in this particular instance because this is a very large report, it’s extremely detailed, and we have just started the process of really drilling into the numbers and actually pulling the cases because the number of cases in terms of mortality is actually just a handful of cases, so we are actually able to pull every single one of those cases and just assure that we are doing everything we can from any case of mortality that occurs after a major surgery.”
McMillan says it may not be wise to make a judgement based on the stats alone “One of the things we have to look at is, these are rates, they are not absolute numbers.” McMillan says the disadvantage for UHNBC is that it is one of the smaller hospitals included in the analysis “One or two cases, or a handful of cases that can be statistically normal in terms of variation, can make a huge difference in rates.”
McMillan says UHNBC is committed to improving everything it does, “It (the data) validates work we are already doing with Northern Health in focusing in a number of areas for quality improvement, we’ve got a whole program in place and we’re implementing a whole structured quality review process in surgery as part of a provincial roll out of a surgical quality improvement program, We’re one of 13 hospitals in the province doing that, and it validates the fact that we’ve focused on these areas. So what it is , is a validation of the direction we’re already going in,.”
He says the problem with putting out numbers without an explanation behind them is that some people may not interpret them correctly “So what I would like to say is, I have every belief that it is very safe to come to have surgery.”
McMillan says it can be challenging when data is offered without an opportunity for people accessing that data to have a conversation about what the data means, but he says it is important for people to know there is a focus on constant quality improvement “We’re absolutely committed, we’re gratified when we do well and again, even when we do well, it doesn’t change our focus on striving to do better.”
Comments
âNorthern populations have higher rates of illness, higher burden of illness and in northern B.C. we have a 20% higher burden of illness than populations in any other part of the province.”
Northern populations have been exposed to the highest concentrations of hexafluorosilicic acid added to tap water and also for the greatest length of time. Many southern areas of the province have NEVER added this kind of effluent fluoride to their drinking water and all of those who did stopped doing so many years ago, some recently, like Williams Lake.
Prince Rupert, Prince George, Terrace and Fort St. John are the only towns left in B.C. (all in Northern B.C.!) who still fluoridate drinking water with an industrial fluoride which is vastly different from the natural calcium fluoride often found in water.
97% of the province is now fluoride addation free – us in the North are the only unnecessary guinea pigs left!
Just a hint, ladies and gentlemen.
What’s up doc?
This is not the first year of information. There is a history of 4 years.
In 2008 it was 5.08 deaths/1,000. The CANADIAN average is around 9 each year.
In 2009 we stood at 13.28; 2010 it was 15.88 and then 2011 16.49.
In other words we have three years of increasing death rates within 5 days of major surgery. Whether the number is relatively small due to the size of the hospital does not really matter. The key is that whether it is surgical procedures or reactions to drugs, the entire medical field is based on statistical probabilities. In this case it is the probability of post operative complications ending in death within 5 days of major srgery when one ends up in the local hospital rather than any other hospital in Canada.
There are many other indicators of how ell the hospital is doing. Some are better, some are worse, some are average.
For instance, in hospital hip fractures for those over 65 is another measure. There were none in 2008; .48/1000 in 2009, which was less than the Canadian average; 1.42 in 2010, which was above the average; 2.36 in 2011. A steady increase in a measure used to indicate patient safety in-hospital.
Some positive news. Readmission within 90 days after hip surgery was 3 times the national average in 2008 and has gone down to match the national average.
30 day in-hospital mortality following stroke has also reduced steadily from 30% above national average in 2008 to national average in 2010 and half the national average in 2011.
Comparing with Royal Inland Hospital in Kamloops, they are at the national average now after 3 years in the 11 range for death rate within 5 years major surgery.
Kelowna General has been at or below the national average.
Vernon has been far below the national average and in the past 2 years at the national average.
The obvious question is, what are the details of why we are so high in this and some other categories?
We have a nice facility with wood in the atrium. But that is not what keeps people safe and alive. Focus on that objective.
BTW, the notion that the numbers may be too low to have any statistical meaning is very familiar to those who did the survey. Those figures are given and are indicated with a different symbol in the report to caution the reader about that fact.
None of the statistics reported in the article or in my post have been identified as statistically meaningless.
“We have a nice facility with wood in the atrium.”
What’s up with the wood, doc?
Public buidings in BC have to have wood in them under the Wood First policy. So the atrium has some wooden beams.
http://www.journalofcommerce.com/article/id35695
What I am saying in between the lines is that they may have met the requirements for that policy, however, I am more concerned about the care of local patients than the meeting of the requirements to keep forestry workers in other parts of the province busy.
For instance, where is Northern Health on this issue?
The First Nations carving is made from wood too! Actually the use of wood is more than just a policy requirement – it actually makes for a warmer ambience.
I would surmise it is circling the wagons!
It does make for a warmer ambience, I agree depending on where it is used.
Ever notice that hospitals tend to have surfaces which allow them to be easily cleaned of dust, dirt on shoes, hands touching walls, rails, etc.?
I am trying to remember why exactly that was. Seem to recall a lecture by some professor about material properties and matching those with the use they are put to in buildings.
She went on to tell us all about those nasty microbes that can grow on surfaces.
But hey, she was probably a bit of a hypochondriac … ;-)
Here is a bit of a promo from a provider of preferred surfaces to minimize vree housing of microbial colonies.
http://www.touchbriefings.com/pdf/13/Hosp031_t_Samsung.pdf
http://www.microbebusters.com/9h_30MonthFieldStudyImprovedControlOfMicrobialExposureA.pdf
Just what is Michael McMillan trying to tell us?
Who knows?
Lots of validation ….Reading through it, it sounds to me like he was caught off guard …. I am sorry, but I cannot make any sense of it. I do not think he has had any time to look at the data otherwise he would know that they were going in the wrong direction with respect to the 5 days post-op stats ….
Oh, by the way. Prince Rupert has suspended water fluoridation until they can raise some money for repairs to their artificial water fluoridation system (AWFS). I suggest that they ask Northern Health (NO Health). They seem to be loaded with money.
Now there are only 3 cities left in B.C.(Ft. St. John, Terrace and us) who still have AWFS. How lucky can we get? Since 1955 yet! Have you checked your teeth lately?
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