Death rate in Cape Breton hospitals said to be worst in Canada for third straight year

For the third straight year, hospitals in and around Sydney, N.S., have recorded the highest death rate in the country, according to the Canadian Institute for Health Information.

CIHI, described on its website as an independent, not-for-profit organization that provides essential information on Canada's health system and the health of Canadians, annually publishes its hospital standardized mortality ratio and other measures on the safety and effectiveness of in-hospital health care.

Joseph Amuah, manager of content for CIHI's "Your Health" website, said the ratio standard is 100. The 2019-2020 ratio in hospitals in Cape Breton Regional Municipality is 143.

"Close to 50 per cent more deaths occurred at this hospital than would have been expected by a statistical model, given the clinical characteristics of the patients," he said.

In fact, the numbers show that for the fifth year in a row, the Cape Breton health-care complex has had a ratio worse than the national average, which is 95. The complex includes the regional hospital in Sydney and community hospitals in New Waterford, Glace Bay and North Sydney.

Dr. Paul MacDonald, a cardiologist at the Cape Breton regional hospital and head of internal medicine for the Nova Scotia Health Authority's Eastern Zone, said the numbers are "very concerning."

"I think what's more concerning than the fact that we're the worst this year is that we were the worst last year and we were the worst the year before," he said.

According to CIHI, the expected number of deaths in CBRM hospitals, based on admissions last year, was 294.

With a ratio of 143, that means 126 additional patients died after being admitted to hospital with a condition that was deemed survivable.

The mortality ratio for the hospitals was 133 last year, down from 158 the previous year.

It was 124 in 2015-16.

It seems like an upward trend, but Amuah said over five years, the numbers are consistently at about the same level.

Trend not significant

The trend is not statistically significant, even though the numbers are high, he said.

"Considering the confidence intervals, I do not recognize a significant trend in general," Amuah said.

"I would say that they are all within the same broad range of results. It would appear that sort of on average, there is sort of a flat level of performance."

The ratio is a calculation that uses 100 to represent the number of deaths expected to occur in hospital.

Anything below that means the hospital saved the lives of patients who were expected to die. A number above 100 means patients died even though they were expected to live.

The measure is only provided for hospitals with 2,500 or more admissions annually. In Nova Scotia, that includes only the CBRM hospitals and the Queen Elizabeth II Health Sciences Centre in Halifax.

The QEII's ratio last year is 105, which is a little worse than the national average, but slightly better than the provincial average of 107.

CBRM hospitals are in the Nova Scotia Health Authority's eastern zone, which has an overall ratio of 118.

Five years ago, the provincial number was 115. It rose two years later to 129, but it is back down to 107.

Amuah said the numbers should not be taken in isolation and should not be used to compare one hospital to another.

The numbers are standardized to account for some variables such as age, sex and some chronic health conditions, so even though Cape Breton typically has an older population with multiple health concerns, those factors are mostly taken into account.

However, Amuah said, there are other factors that can skew the numbers. For example, some hospitals offer specialized surgeries or other services that aren't available at all hospitals.

Still, he said, the numbers are intended to give hospitals a measure they can use to compare themselves over time.

CBRM hospitals are within the normal range on some measures, such as access to hip fracture surgery within 48 hours, obstetric trauma with an instrument and all patients readmitted after treatment.

Sepsis, other measures also high

However, the hospitals fared poorly in other categories.

For example, seven out of every 1,000 patients last year contracted sepsis in hospital, which is about double the national average.

The number of pediatric patients readmitted after a hospital stay is also higher than average, as is the number of patients with low-risk pregnancies getting caesarean sections.

Two years ago, when the Cape Breton hospitals' HSMR peaked at 158, the health authority said it discovered some of the data it sent to CIHI was wrong. It said the charts of some patients had been coded incorrectly.

It turned out only two per cent of the data was incorrect, but the health authority also said it was standardizing nine processes that would help improve the numbers.

Steps taken, but unsuccessful

Last year, the ratio did drop to 133, but it has now jumped back up.

When asked for comment, the health authority put forward MacDonald.

He said even though provincial health officials have said they take the concerns seriously, there has been a lot of talk, but little action.

"There have been steps that have been taken within the hospital to try and change those outcomes, but they have not yet been successful," MacDonald said.

"Unfortunately, it's a sad excuse that people make when they don't like numbers and that is they start to blame the methodology and ... say perhaps it's a coding issue, instead of spending that energy saying, 'Where do we have deficiencies in the hospital' and asking the people who are working on the front lines, 'Where do we need more support?'"

Underequipped and understaffed

Sepsis infection and heart failure have been major issues, but there's probably a wide variety of causes for the high mortality rate, MacDonald said.

He said local hospital staff are smart and dedicated, but they have been asking for additional staff and equipment for years.

"There's a lot of areas of need within the hospital and as yet we haven't seen a strong response from the health authority to try and correct these things and so, unfortunately, once again our numbers are the worst in the country," MacDonald said.

"When you see these numbers over and over again, it doesn't feel like they've [provided] sufficient resources to fix things. If the house is on fire, you have to marshal extra resources to fix things."

MacDonald said requests for extra staffing and equipment are routinely denied by health authority officials outside Cape Breton, either for budgetary or other reasons.

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