Violence in hospitals gets out of hand

Violence seems a part of life for those working on the front lines of this country's health care system.

The impact of workplace violence on the health care industry is enormous, exacting a heavy financial toll, according to a 2006 survey by the Workers' Compensation Board of British Columbia.

Facts in figures concerning violence against health care workers:

Injury claims

Nine percent of all B.C. health care workers' accepted claims are due to violence.

More than half of the accepted B.C. claims for health care workers are from nurses aides and licensed practical nurses.

One in five of the accepted B.C. claims for healthcare workers, due to violence in the workplace, is from registered nurses.

$24-million was spent from 2002 to 2006 in workers compensation claims involving violence against health-care workers, including physicians, nurses, care aides, pharmacists, housekeeping staff, technicians and administration.

162,934 days were lost in 2006 due to accepted claims of violence against health care workers in B.C.

Fourteen B.C. health workers were injured every week in 2006, as recorded in accepted violence claims.

Most often hurt workers' body parts in attacks

Arms, including wrists, fingers and elbows: 27 percent

Backs and shoulders: 25 percent

Head, including neck, face, eyes, ears and scalp: 14 percent

Violence against nurses in Canada:

A national survey of nearly 19,000 nurses done by the Canadian Institute for Health Information, Health Canada and Statistics Canada in 2005 found the following:

29.6 Percent of nurses working in hospital said they were physically assaulted by a patient over the past 12 months

49.6 Percent of nurses who worked in a long-term care facility, such as a nursing home, said they were physically assaulted by a patient over the past 12 months

43.6 Percent of male nurses have faced physical assaults, be they in hospital, nursing homes, a community health centre or other health care settings

27.9 Percent of female nurses have faced physical assaults in the same settings

46.3 Percent of nurses working in a hospital said they were emotionally abused by a patient over the past 12 months

48 Percent of nurses working in long-term care facilities, such as nursing homes, said they were emotionally abused by a patient in the past 12 months

54.3 Percent of male nurses have reported suffering emotional abuse over the past 12 months, be it in a hospital, nursing home, a community health centre or other health-care related settings

43 Percent of female nurses have reported suffering emotional abuse in the same settings

46.7 Percent of nurses under 35 reported they have been emotionally abused by a patient in the past 12 months

38.2 Percent of nurses over 55 reported they have been emotionally abused by a patient in the past 12 months

Humber River Regional highest death rate, not Scarborough General

On orders from the provincial health ministry, Humber River Regional Hospital quietly released the worst death rate of any Toronto-area hospital.

On Monday, more than a week after the Canadian Institute for Health Information published a high-profile report containing death rates for hospitals across Canada, Humber broke its silence to report a rate of 136, meaning its in-hospital death rate was 36 points above the national average of 100.

Humber's rate is the second worst in Canada. Only Kitchener's Grand River Hospital fared worse, with a rate of 142.

The release of Humber's data also boosts Scarborough General Hospital to second worst in the GTA; its death rate was 134.

Humber's figures were omitted from the CIHI report because hospital officials insisted data inconsistencies had skewed the numbers. Hospital officials ultimately released the numbers in a brief statement on a media wire service. Calls to three Humber representatives were not returned yesterday.

The disclosure came at the insistence of the provincial government.

On Dec. 4, Health Minister George Smitherman told the Legislature that Humber would release its numbers in one week.

"My office has been in touch with Humber River Regional Hospital. In the interests of transparency, I'm pleased to tell the House that they'll be releasing their data within a week," he said in response to a question from Laura Albanese, MPP for York South-Weston.

"By next year, our government will have passed a regulation that would require all hospitals to report this data, without exemption, to ensure this information continues to drive much-needed improvements in patient safety."

Humber cited a "misunderstanding" in the data related to end-of-life care (palliative and "do not resuscitate" cases) as the reason for its numbers not being publicly released as part of the CIHI press conference Nov. 29.

Mortality rates for 85 large, Canadian, acute-care hospitals and 42 health regions, except Quebec, were released at the news conference for the first time.

"The coding discrepancies were serious enough that to release the (data) presented in the preliminary report would be misleading," the hospital said in a statement.

It said they "embrace the concept that patients deserve transparency and accountability from public institutions" and that the latest numbers show they are "producing significant improvement" in data quality.

However, CIHI told the Star yesterday Humber's rate of 136 is the same as in its original calculations.

The non-profit CIHI uses the hospital standardized mortality ratio, which looks at 65 illnesses that account for 80 per cent of in-hospital deaths, to prepare its report. Anything below 100 is better than average, anything above is worse.

The figures exclude patients in palliative care.

All the numbers crunched by CIHI were sent to the hospitals in early autumn so they could be checked, said CIHI's Christina Lawand.

Grand River officials also say their ranking is misleading. "As a consequence of incorrectly filed data sent to CIHI, over 32 percent of the mortalities included in the Grand River Hospital's ranking should not have been counted because they were in fact palliative care patients being provided end-of-life comfort, not curative, care," said Nancy Hewat, Grand River's executive director of foundation and public affairs.

In Toronto, the University Health Network had the best overall rate, 87, for its three-hospital system. The now-closed Peel Memorial Hospital also had a low rate, 81.

For years, Canadian hospital administrators have known the death rates inside their hospitals but they were never publicized. The disclosure followed a year-long Toronto Star investigation into medical secrecy that examined the lack of information available to patients. As part of the series, the Star urged the public reporting of death rates.

Humber was created in 1997 by the merger of Humber Memorial, Northwestern General and York-Finch General Hospital. It sees about 365,000 outpatients each year and has 100,000 emergency visits, according to its website.

Smitherman told the Legislature his government sees transparency as something that is "powerful and beneficial to our patients."

He also announced that by the beginning of April it will require all hospitals involved in Ontario's Wait Time Strategy to report infection rates in three areas.

And, by the end of July, it will introduce a regulation requiring all provincial hospitals to inform patients about medical errors.
The Star

Editor's opinion:

"I was kind of expecting this when Humber River General was reported to be the only hospital that hadn't submitted the numbers yet (read related article).

That to me, was really suspicious!"

Related article:

Scarborough General Hospital highest death rate in the GTA

Ontario physicians best paid

Ontario is even more competitive in physician compensation than figures reported today by the Canadian Institute for Health Information (CIHI) said Deputy Premier and Minister of Health and Long-Term Care George Smitherman.

Today, CIHI released Physicians in Canada: Average Gross Fee-for-Service Payments which covers the 2005/06 year. (download the report here)

"We are headed in the right direction in making Ontario an employer of choice in health care," said Smitherman.
"I look forward to building on this success with our doctors so that an additional 500,000 Ontarians can benefit from family health care."

Since the year that the report captures, the ministry has invested a further $652 million for physicians that includes incentives to enroll more patients and to treat people with chronic diseases.
Beginning in 2008, an additional $364 million will flow to doctors in recognition of the important care they provide to patients. Total investments in this deal will total $1.3 billion annually in physician services.
By working together, the McGuinty government and Ontario's doctors have been able to increase the number of Ontarians with access to a family doctor. Based on independent survey data and data from Statistics Canada, the number of Ontarians with regular access to a family doctor has increased by 500,000.

The additional $652 million of funds dedicated to doctors is being used as follows:

• $285 million to provide Ontarians access to family health care;
• $290 million for better hospital care in areas such as emergency rooms and palliative care;
• $77 million for other areas such as chronic disease management, psychiatry and surgical services.

More info: http://www.health.gov.on.ca

source: CNW Group

New Brunswick health care workers highest absence rate

New Brunswick health care workers posted the highest absenteeism rates in the country last year, according to numbers released last Monday by the Canadian Institute for Health Information.

Provincial health workers, ages 25 to 54, logged an average of 16.1 lost days in 2006.

That figure is more than double that of Alberta, which had the lowest numbers, at 7.2 lost days. Nova Scotia recorded a rate of 9.7. Manitoba placed second last, just ahead of New Brunswick, with an average of 16 days lost. The national average was 12 days.

The report, titled Canada’s Health Care Providers, notes such levels far exceed national averages for the general workforce.

Scarborough General Hospital highest death rate in the GTA

"Health care experts say the numbers will force medical officials to examine their practices and improve patient care".

Scarborough General Hospital has the highest rate of deaths in the Toronto area – and the third highest in Canada – according to a watershed report that made hospital death rates public last week.
It's the first time in history that a report of this kind this has been done.

The hospital with the lowest rate of deaths in the GTA is the University Health Network, which includes Princess Margaret, Toronto General and Toronto Western Hospitals.

The Canadian Institute for Health Information (CIHI) released mortality rates for 85 large Canadian acute care hospitals and 42 health regions in every province but Quebec, where they don't collect the same data. Health care experts say the figures, which show how effective hospitals are at avoiding preventable deaths, will force medical officials to examine their practices and improve patient care.

For years, Canadian hospital administrators have known what death rates were inside their hospitals, but unlike the United States and the United Kingdom, they were never made public.

The only hospital in the Greater Toronto Area that CIHI did not release figures for was the Humber River Regional Hospital.

"For this report we got our preliminary results back and when we saw them we said: Hold on, we've got some concerns here," said Gerrard Power, a hospital spokesperson.

"It's important all hospitals report the information so they can figure out the problems and fix them," said Dr. Alan Hudson, head of Ontario's wait time strategy.

"This is an absolutely crucial day for the province of Ontario. It is a major step," said Hudson, a neurosurgeon. "The whole process should be transparent. Taxpayers deserve nothing less."

The long-awaited disclosure follows a year-long Toronto Star investigation into medical secrecy that raised questions about a lack of public reporting in Canada. As part of the investigative series Medical Secrets, the Star urged CIHI to reveal hospital names with reportable data.

The provincial government has mandated that the 1st of April 2008 all Ontario hospitals report adverse events and death rates for certain procedures on their websites along with wait time information.

The CIHI study compares the actual number of deaths in hospital with the average Canadian experience. The numerical result is called the hospital standardized mortality ratio (HSMR). A score above 100 means a hospital is above the national average while a score below that figure reflects a lower mortality rate.

The University Health Network scored an 87, or 13 points below the national average of 100. For years, the UHN has reported patient safety data on its website, from hospital-borne infection rates to wait times.

The UHN has also brought in rapid response care teams, which have helped to bring down death rates at its hospitals. These are groups of intensive care doctors and nurses that can quickly respond to a patient experiencing anything from a cardiac arrest to a drastic drop in blood pressure.

Bell has been a vocal supporter of publicizing death rates. "The data reflects the comparative experience of patients in your hospital related to other hospitals," he explained. "This gives hospital caregivers and managers a concrete goal they can set objectives with and they can use to initiate quality improvements."

Many experts believe public reporting allows hospitals to compare patient outcome records, see where they rank on important indicators and spot trends that could lead to changes that better protect public safety. Public reporting also provides patients with access to information about potential risks and problems inside their local hospitals before they seek treatment.

The Scarborough Hospital's General site scored 134, while the Grace site scored 110. The hospital has suffered from management turmoil, as well as allegations of lax oversight of physicians.

Dr. Steven Jackson, chief of medical staff at the hospital, said management is committed to lowering the numbers and beating the national average. "Everyone is buying into this," he said. "Quality is where we are going."

The figures released last week are viewed as a key indicator of patient safety levels in hospitals, an area of growing interest for medical experts. Between 9,250 and 23,750 Canadian adults experience a "preventable" adverse event in hospital and later die, according to a 2004 CIHI study. Over the past three years – the period covered by the new data – more than 254,000 patients died in Canadian hospitals outside Quebec.

"Releasing these numbers across Canada is a big step forward," said Hilary Short, president of the Ontario Hospital Association, representing all hospitals in the province. "It's hard the first time you release a report like this," she said. "But once you start reporting publicly it really accelerates ... and it forces improvement."

Now, for the numbers:

Canada's best and worst

The following hospitals had mortality ratios (excluding palliative care) ranking at the top and bottom of the list of 85 larger, acute care hospitals in 42 health regions across Canada (excluding Quebec), according to the CIHI survey of hospital deaths.

Top Five

1. The Moncton Hospital - Moncton, N.B.: 56

2. Foothills Medical Centre - Calgary, Alta.: 61

3. Regina General Hospital - Regina, Sask.: 71

4. Peter Lougheed Centre - Calgary, Alta.: 73

5. Saint John Regional Hospital - Saint John, N.B.: 74

Bottom Five

1. Grand River Hospital - K.W. Health Centre, Kitchener, Ont: 142

2. Niagara Health System - St. Catharines General Site, St. Catharines, Ont.: 135

3. The Scarborough Hospital - General Site, Toronto, Ont.: 134

4. Burnaby Hospital - Burnaby, B.C.: 125

5. Red Deer Regional Hospital Centre - Red Deer, Alta.: 125

The Moncton Hospital, N.B. - "lowest death rate in Canada"

The Star