Several Fraser Health Authority hospitals have some of the worst results in Canada on various measures of patient safety and quality of care, according to a report prepared for the ministry of health and released Wednesday.
The most recent Canadian Hospital Reporting Project shows that Burnaby Hospital was the worst in Canada from 2010 to 2012 in a category called “nursing-sensitive adverse events.” The category is a patient safety and quality of care indicator because complications typically stem from hospital care or lack thereof, as opposed to a patient’s illness. The report studied the rate per 1,000 patients of such conditions as urinary tract infections, pressure ulcers, in-hospital falls leading to fractures and pneumonia.
In studies, the conditions are often said to be associated with nursing staff levels. Surrey Memorial Hospital performed worse than 98 per cent of similarly sized hospitals and Royal Columbian fared only slightly better, with 92 per cent of peer hospitals performing better in 2010-11 and 83 per cent doing better in 2011-12. For medium-sized community hospitals, Ridge Meadows was also near the bottom, with 99 per cent of like-sized hospitals performing better in 2010-11 and 88 per cent doing better in 2011-12.
“These outcomes are particularly concerning, considering that the majority of surgeries that occur in Fraser Health are performed in these three (big) hospitals,” stated the report, prepared for the health ministry in its seven-month review of Fraser Health. The report said Surrey Memorial had many quality indicator red flags warranting deeper investigation relating to infection control, hand hygiene compliance, delays in fixing broken hips within 48 hours, patient satisfaction and other measures of quality and safety.
At a news conference held in the Vancouver cabinet offices Wednesday, health minister Terry Lake said hiring more nurses is one of the priorities for Fraser Health leaders. While insisting that problems aren’t all due to budget shortfalls, he nevertheless announced $60 million more in funding for Fraser Health over the next two years, on top of the $3.1 billion from government in the 2014/15 fiscal year and $3.2 billion in 2015/16.
“We are hiring more nurses. I think there’s a couple hundred more nurses that have been hired recently in Fraser Health with the expansion at Surrey Memorial, for instance. And we’re working very closely through the last collective agreement with nurses to ensure that we are hiring the extra number of nurses that we agreed to and we’re on track to do that.
“Then again, it’s about the appropriateness and utilizing the highly trained skills of nurses in appropriate fashion, so making sure that we are using their skills to the highest level possible, particularly in team-based care to make sure that patients are best served and that nurses don’t get burned out because that’s important for us that we want a sustainable, healthy workforce.”
Lake praised the work done by “amazing, dedicated, skilled people …(who are like) unsung heroes” but he said the additional money is needed to improve the quality of certain indicators of patient care and safety.
Some of the other problems identified by Lake as needing attention include getting patients discharged from hospitals faster, since the risk of hospital-acquired infections and other complications go up as patients have more exposure to hospital germs. Lake said it’s not that Fraser Health has too few hospital beds, it’s that more than a third of patients admitted to hospital are staying too long.
The review contains numerous reports and one of them would appear to undermine Lake’s contention that there are enough hospital beds. It shows that from 2008 to 2013, Fraser Health had patient occupancy rates above 100 per cent, which is why so many patients end up in hallways. For example, Mission Memorial had a whopping 136.7 per cent occupancy rate for the year ending in 2012/13.
For at least the past five years, the authority has had the worst rates of any health region in the province when it comes to getting emergency patients admitted into hospital beds in under 10 hours. Only 55 per cent of such patients were admitted in that time frame last year.
“Given current practices, FH has insufficient acute beds to meet current demand. A short-term increase in acute bed capacity, distributed appropriately, could then be implemented to allow administrators and health care providers to focus ... on decongestion strategies,” the report states.
Lake said news reports about patients suffering or dying after falls in hospitals or medical mistakes are not the norm — they are “outliers.” But he acknowledged there’s room for improvement. The report echoes that:
“This suggests further education of both medical and nursing staff needs to take place, as well as more effective use of daily safety huddles,” according to a government document.
The review identified several other areas where Fraser Health facilities need to improve: hospital mortality rates; immunization rates for measles, mumps and rubella; decreasing overtime of nurses; boosting mental health services; and increasing residential care beds — the latter said to be 300 short of the B.C. per capita average.
Lake asserted there is an over-reliance on acute care hospital beds across the Fraser region and that care has to shift to communities and homes. Too many patients are going to emergency departments for care they should be able to get elsewhere, he said. The report found that 550,000 ER visits took place at Fraser Health hospitals in 2012/2013. Use of emergency rooms is increasing 6.5 per cent annually, far higher than population increases of 1.7 per cent.
One changes being studied to help take the strain off involves hiving off the Burnaby Hospital and geographic region and making it part of Vancouver Coastal, since about half of patients in Burnaby get their care in that region. The change in health region boundaries is not expected to take place without a full consultation with the public and health providers, a process that could take up to a year.
The health ministry’s report comes weeks after Dr. Nigel Murray, the former CEO of the region, resigned, to take a job in his homeland of New Zealand. Murray was the highest-paid health authority CEO in B.C., earning $444,000 in total annual compensation. A search for a successor is underway and that individual will be asked to take far less, about $348,000, said Wynne Powell, the recently retired CEO of London Drugs and chairman of the Provincial Health Services Authority. He was seconded by the health minister to also serve as the volunteer interim chairman of the board at Fraser Health.
Dr. David Ostrow, the former CEO of Vancouver Coastal Health, was asked to come out of his brief retirement to serve as interim CEO of Fraser Health.
Powell resisted any direct jabs at Murray, but said he thinks the leadership and board of the region met too infrequently and focused too much on day-to-day operations rather than big-picture issues. He has now ushered in an era of twice as many board meetings and wants board members to receive far better briefing notes so they can think more critically.
Powell said he has been extremely hands-on throughout the review process, even meeting with hospital cleaners.
”I’ve even gone around talking to janitors, asking them to do a little bit more. Things like cleanliness and hand washing rates have to go up.”
Fraser Health serves a population of 1.7 million — the most populous and fastest-growing region in B.C.
Lake ordered the review last fall after the health authority faced a barrage of criticism on various issues:
• Fraser Health failed to meet its budget for three years in a row despite six-per-cent annual budget increases. Other health authorities got an average 4.8 per cent annual budget increases.
• Continued hospital congestion leading to patients waiting and being treated in hallways.
• In October 2013, a 90-year-old woman was sent home from the Ladner hospital at 2 a.m. in pyjamas and without shoes. Vivian Fitzpatrick was discharged from the hospital and sent home by cab, bleeding from a medical procedure and wrapped in a bedsheet.
• Recurring difficulties with so-called super-bugs and hospital-acquired infections such as C. difficile and other antibiotic resistant bacteria.
The Vancouver Sun has also reported on various tragedies at Fraser Health hospitals, including the recent death after a fall of a cancer patient. And at Royal Columbian Hospital, the catastrophic labour and delivery experience of a couple (a nurse and her law enforcement husband) whose infant died as a result of medical errors for which the hospital apologized.
