Your Hospital – Safety and Quality Come First
- December 2007
- Français
In the complex and ever-changing world of hospital health care, patient safety and quality initiatives come first, every time. There are many ways we measure quality and many projects and initiatives in place to ensure patient safety is at the forefront of what we do every day at the Niagara Health System.
About 35,000 patients are admitted to our hospital sites each year and an astonishing 245,000 patients come through our doors for outpatient clinics. More than 200,000 patients use our emergency departments each year. To ensure these patients are receiving top-notch care, we use a number of tools to monitor and measure patient outcomes, says Dr. Bill Shragge, NHS Chief of Staff.
"As a hospital, it is our duty to use all the information available to us to identify ways to improve care to our patients," Dr. Shragge says. "We study a wide range of indicators, including the Ontario Hospital Report which measures hospital performance in a number of areas and indicators from Ontario's Wait Time Strategy, to name a few."
Quality Improvement Tools
An additional tool available to hospitals comes from the Canadian Institute of Health Information (CIHI), an agency which gathers patient/hospital data from across the country and analyzes it for a wide-ranging audience. CIHI has issued a new data set, called Hospital Standardized Mortality Ratio (HSMR).
"To better use the data from CIHI, Niagara Health System has established an HSMR review team, made up of physician leaders and other in-house experts to analyze our results and identify quality improvement opportunities on an ongoing basis," says Dr. Jeff Cranford, General Surgeon and Physician Lead at St. Catharines General Site.
Understanding HSMR
"There are various factors which influence an individual hospital's HSMR results," Dr. Cranford says. "HSMR is complex indicator and it is important to look at the local context for individual hospitals when considering the data. A simple interpretation is almost impossible because there are so many external factors outside our control."
For the NHS, these factors include major challenges, such as shortages in Niagara of health professionals, specifically family doctors and nurses and the high prevalence of chronic disease. As well, there is the ongoing effect of alternate level of care patients residing in hospital acute and complex continuing care beds each day. These patients belong in long term care or rehabilitation facilities but there is a long-standing shortage of these beds, as well as community palliative and hospice care in Niagara.
"With the high prevalence of chronic heart disease, cancer and kidney disease in Niagara, the poor socio-economic status of the region and the significant shortage of family practitioners, we are seeing more and more patients coming into hospital at advanced stages in their illness," says Dr. Cranford. "This reality is a contributing factor to our HSMR results.
Through the past two years, the NHS has introduced a number of quality improvement initiatives . These include the introduction of Hospitalists at our three large community hospitals and our Port Colborne General site and a series of new standardized protocols for patient care and treatment in ICU and medical and surgical wards.
The recent introduction of an Intensivist-led intensive care unit (ICU) at St. Catharines General Site is a significant quality improvement initiative. With this new model, patients from across Niagara requiring the most intensive critical care services receive their care at the St. Catharines ICU, where they remain under the care of a dedicated Intensivist physician, who is a specialist in critical care. Numerous medical studies show that this type of model improves patient outcomes.
HSMR results have just been received for the first quarter of 2007/08 and they show significant positive improvement. "Our NHS HSMR cumulative result has significantly decreased from 124 to 109 – a great result that most likely reflects the quality and safety initiatives we have put in place," said Dr. Shragge. "The HSMR result for our SCG site is also significantly improved with a reduction from 131 to 121. The 95% confidence interval achieved in our first quarter results demonstrates that we are not statistically different from the national result."
"As a health-care organization, we are fully committed to continuous quality improvement. We look forward to using the HSMR information as another quality improvement tool to enhance the care and service we provide to patients here in Niagara," adds Dr. Shragge.
For more information on Quality and Patient Safety at NHS click HERE.