The details are out on the Canadian Institute for
Health Information’s (CIHI) Canadian Hospital Reporting Project – and our
hospital has above average results overall.
We also have several areas that require more focus
and actions to improve for patients. We view the CIHI report as an opportunity
to examine our services and improve.
Data from the report showed the performances of more
than 600 acute care hospitals from all provinces and territories in the country
covering the fiscal years from 2007–08 to 2010–11 in 21 clinical indicators and
nine financial indicators.
When looking at the four fiscal years covered in the
report, our hospital fares well compared to the national and provincial
averages for the 21 clinical indicators. We’re better than average on 14 of
them.
Better than
average
There are many examples of better than average
results in the report for Rouge Valley.
· 5-Day In-Hospital Mortality
Following Major Surgery – Above average. In fact, we ranked fifth of 19 Greater Toronto Area
hospitals in the category, as reported by The Toronto Star.
·
28-Day Readmission After Acute
Myocardial Infarction (AMI or heart attack) – As the regionally
designated centre in cardiac care, we are proud of this result.
·
Use of Coronary Angiography
Following Acute Myocardial Infarction (AMI) – RVHS is better than the
national and provincial averages for all four years.
·
90-Day Readmission After Hip
Replacement – RVHS was worse than the national and provincial
averages in 2007-08 and 2008-09, but has improved to better than the average
for the last two fiscal years in this category.
·
30-Day Readmission Rate
(Obstetric, Paediatric, Adult
Surgical, Adult
Medical and Overall) – Data for these indicators are
only reported for 2009-10, in which RVHS was better than the national and
provincial averages.
·
Obstetrical Trauma for Vaginal
Delivery With Instrument and in Obstetrical
Trauma for Vaginal Delivery Without Instrument
– RVHS is better than the national and provincial averages for all four years
for both indicators.
Worse than
average
There are a handful of areas listed in the report
which we are reviewing and working to improve on for patients and our
communities.
· C-section
Rate (Excluding Pre-Term and Multiple Gestations) and Vaginal Birth After
C-Section (VBAC) Rate – RVHS is higher than the
national and provincial average for all years reported for both indicators.
· 30-Day
In-Hospital Mortality following Acute Myocardial Infarction (AMI)
– RVHS was better than the national and provincial average in the first two
years, but has become higher in the final two years reported on. We are examining the factors that contributed to this
result. As the regional centre for cardiac care, we see a variety of heart
attack patients in dire need of our expertise. We will take the report’s
findings as a further motivation to examine how we can improve our highly
specialized services for patients. Our readmission rate after AMI,
for example, is better than the average in the report, so we know there are
daily success stories in our cardiac program. This downturn
may be tied to introducing the Code STEMI Program in February 2009, serving
Scarborough; and in February 2010, fully expanded to Durham.
Measures that have been implemented to improve care of AMI patients
include:
- Increased
focus on clinical guidelines and order sets, medication reconciliation
practices, patient and family education programs, coordination with pre- and
post-hospital providers, cardiac support programs;
- Quality
improvement committees, participation in quality collaboratives; holding staff
accountable for quality;
- Communication
and coordination among providers;
- Problem
solving and continuous learning;
- Development
of a cardiology focus unit with enhanced staff presence and expertise in AMI
care; sustained cardiologist physician champions, empowered nurses, involved
pharmacists.
· Administrative Service as a Percent
of Total Expenses – RVHS is worse than the national and provincial averages
for all three years reported.
· Cost
per Weighted Case – RVHS is higher than the provincial average
for all three years reported, reflecting that it is more expensive to deliver
care at RVHS than the average hospital.
As I said we’re working on
all of these. I should elaborate also on the administrative service cost
percentage, in which we are listed as being the worst in the province.
In 2009/10, the most recent year for which data is
available, the provincial average for administrative expense was 5.92 per cent.
RVHS’ was at 8.79 per cent. There are a few reasons for this including:
·
Severance costs
and early retirement incentives as part of our necessary and very well publicized
Deficit Elimination Plan for 2008-2011; and
·
Insurance
premium increases stemming from a fraud discovered in 2007 and an old class
action lawsuit dating back to the late 1990s. These are included as
administrative costs in the CIHI report, and if reduced to normalized amounts, then
RVHS’ administrative costs would be in line with the Ontario provincial average.
The hospital has been steadily improving its quality
of patient care and improved overall safety — which will gradually push down
our insurance premiums over time.
As part of our strategic plan, improving the patient
experience is our number one priority and daily mission. As our staff and
physician team knows very well, we have been applying a Lean philosophy of
constant improvement for patients since 2008. That is having a positive impact
on patient readmission rates, wait times and quality of care in general. All of
this will have a favourable impact on our insurance premiums, which are included
in the percentage of administrative overhead listed in the CIHI report.
It’s important to note that our admin costs continue
to drop in 2010/11 and in 2011/12, but are still high because of insurance and
ongoing severance costs incurred through ongoing restructuring.
Given the new funding formulas being introduced this
year, the continuous pressure to reduce costs will escalate and will continue
for several years. Based on these changes I foresee that severance costs will
continue as we constantly restructure to meet these challenges. By its very
nature insurance will continue to be high for another several years even
without any major claims as we continue to pay off the old claims.
There is so much we can
learn from in the CIHI report, as in other substantive reports done on
hospitals. We will focus on improving our patient care in all areas, including
those in which we are worse than average and those many areas in which we are
better than average.
Our goal has been, and
remains, to be the best at what we do for our patients.
(Read the entire CIHI report on its website.)
(Read the entire CIHI report on its website.)
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