A study that uses big data to compare hospitals across Canada shows that Ottawa’s acute care facilities perform well compared to others in the country — but at a price.
As a group, hospitals in Ottawa’s regional health authority, the Champlain LHIN, performed at or better than the Canadian average when assessed on key measures of quality such as emergency department wait times, patient readmission rates, infection rates, hospital death rates and wait times for hip fracture surgery.
The Canadian Institute for Health Information (CIHI) data shows that hospitals in the Champlain LHIN fared poorly in only one category: the rate of medically unnecessary caesarean sections.
But the enviable performance of the region’s 16 acute-care facilities also came with an unusually large sticker price.
In 2012-13, the average cost of a hospital in-patient stay in the Ottawa region was $5,917 — more than 10 per cent above the provincial average and about six per cent beyond the national average.
Health care officials in Ottawa warned that those numbers have to be approached with some caution since not all hospitals in Canada account for patient costs in the same way. Still, they welcomed insights from the data.
“To have that ability to compare is fundamentally important for an institution to get better,” said Dr. Alan Forster, The Ottawa Hospital’s chief quality and performance officer.
Local health care officials, he added, can’t ignore the cost disparity with other regions even though some of the number crunching may be flawed.
“We can’t live in a situation where we’re spending more than other people so our challenge as an institution — and for all the doctors and nurses and pharmacists that work here — is to find a way to provide better quality for less money,” Dr. Forster said. “It means we have to work smarter and figure out better ways of doing things.”
Champlain LHIN CEO Chantale LeClerc said the region’s health costs may be higher because it combines rural hospitals, which tend to have higher administrative costs, with a large teaching institution, The Ottawa Hospital, that employs extra staff to train new doctors and nurses.
LeClerc said the health authority is analyzing the data to gain a better understanding of what’s behind the cost gap.
As it stands, taxpayers in the rest of the province are essentially subsidizing health care in Ottawa.
An unprecedented amount of data about local hospitals is now available on CIHI’s new, interactive website, YourHealthSystem.cihi.ca, which was unveiled Thursday. It allows both patients and health care managers to compare the performance of hospitals, health regions and provinces based on metrics related to quality of care, patient safety, efficiency and effectiveness.
Local hospitals fare well in all but one of 14 performance indicators: unnecessary C-sections. In the Champlain LHIN, 17.2 per cent of mothers with low-risk pregnancies had C-sections. That was considerably higher than the provincial (15.4 per cent) or national (14.1 per cent) rates.
CIHI officials contend the scorecard will allow hospitals to emulate best practices from similar institutions with proven track records.
The individual scorecards for local hospitals also revealed some interesting anomalies:
The Montfort Hospital reported an average emergency department wait time of 5.9 hours — a mind-numbing 2.7 hours longer than the national average
The Cornwall Community Hospital enjoyed the region’s shortest average emergency room wait time (2.4 hours); the Children’s Hospital of Eastern Ontario was Ottawa’s best at 3.2 hours, the national average
The Ottawa Hospital excelled at delivering hip fracture surgery quickly: 89.5 per cent of patients admitted to hospital with the painful ailment were operated on within 48 hours. (The national average was 82.5 per cent.)
The Ottawa Hospital reported the city’s highest sepsis rate: for every 1,000 patients discharged, 5.7 suffered the complication which results from a secondary infection. Sepsis rates for the country (4.4), province (5.0), and region (4.7) were all lower.
Almonte General Hospital had the region’s highest sepsis rate (9.7)
At The Ottawa Hospital, the region’s main trauma centre, officials said data from the national scorecard will allow them to review their medical practices and improve care.
Ottawa Hospital CEO Jack Kitts, a longtime advocate for improved data, pushed hard for the creation of CIHI’s national scorecard. The hospital has been collecting similar data for at least three years.
“We felt that we couldn’t get better unless we shared our data to understand where we can improve,” Dr. Forster said.
Already, he noted, the hospital has used that data to inform the development of a program to reduce surgical site infections, which often lead to sepsis. Sepsis is a potentially life-threatening condition that commonly results from bacteria entering the bloodstream. It triggers a massive immune system response that can lead to dangerous swelling, blood clotting and organ failure.
The new program to fight it, known as the Comprehensive Unit-based Safety Program (CUSP), draws together surgeons, anesthetists, nurses and housekeepers in a combined effort to reduce the hospital infection rate.
Among other things, patients now receive preventive antibiotics before and during surgery; surgical patients are kept warm to increase their natural ability to fight infection; traffic has been reduced in operating rooms; and physicians sometimes change their gloves and gowns during an operation to reduce the possibility of contaminating a surgical site.
Philippe Marleau, Montfort’s vice-president of quality and organizational performance, said the hospital has recently hired nurse practitioners in its emergency room to cut down on wait times. “We expect to see positive results from this initiative in the months to come,” Marleau said.
The number of patients from West Quebec seeking treatment at the Montfort has increased substantially during the past five years, and the hospital is also trying to discourage those with chronic conditions from coming across the border for care.
Marleau noted that Montfort scored particularly well on an important measure of quality care: the rate of patient readmission to hospital within 30 days of a discharge. Both Montfort and Queensway Carleton hospitals recorded a 7.5 per cent readmission rate, well below the Ontario average of 8.9 per cent.
aduffy@ottawacitizen.com
How do Ottawa hospitals measure up against others in the province and in Canada?