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
