In an effort to improve care and reduce patient deaths, UHN, along with other Canadian health care organizations, is tracking mortality in comparison to the overall national average. The Canadian Institute for Health Information (CIHI) publishes the Hospital Standardized Mortality Ratio (HSMR) for all Canadian health care organizations, which allows UHN and other hospitals to follow their HSMR and track their successes.
Similar campaigns in the United Kingdom and the United States have helped identify areas for performance improvement including prevention of surgical infection, ventilator-associated pneumonia, and central line-associated bloodstream infection. Other areas of improvement include best practice treatment for heart patients and prevention of falls and pressure ulcers.
The standardized mortality ratio is calculated on a monthly, quarterly and annual basis and the change in UHN's score is tracked over time. Observing mortality rates helps assess the effectiveness of performance improvement strategies, which will ultimately strengthen the quality of care provided at UHN.
The HSMR is the ratio of actual number of deaths to the expected number of deaths among hospitalized patients. The number of expected deaths is based on the average experience of all Canadian acute hospitals. The HSMR is based on patient groups that account for 80% of deaths in acute care hospitals. In addition, the HSMR takes into account factors that affect mortality such as age, sex, and length of stay.
An HSMR equal to 100 suggests that there is no difference between the hospital’s mortality rate and the overall average rate; greater than 100 suggests that the mortality rate is higher than the overall average; and less than 100 suggests that the mortality rate is lower than the overall average.
This measure excludes patients whose most responsible diagnosis is palliative care (patients whose hospitalization was for the purpose of palliative care or patients who received palliative care for the largest portion of their hospital stay), and includes patients who were admitted as acute care cases and received some palliative care (not representing the largest portion of their length of stay).
In fiscal year 2018/19, UHN recorded an overall HSMR of 93, which was lower than the expected mortality rate for the patient population treated at UHN.
UHN has the goal of improving patient-centred care by implementing best practices and ensuring patient safety. For example, UHN has the objective of improving hand washing practice in an effort to prevent the spread of hospital-acquired infections.
UHN is actively participating in Safer Healthcare Now initiatives including establishment of the Critical Care Response Team, which quickly identifies and facilitates the resuscitation of inpatients. These and other patient safety initiatives will ensure continued commitment to reducing patient mortality.