DATA: How safe & effective is your local hospital?

If you need a hospital bed in the Fraser Valley, be prepared to wait at least half a day in the emergency room.

Over the last year, three-quarters of all patients admitted to Fraser Valley hospitals waited more than 10 hours in the emergency room, new records show.

Chilliwack General Hospital was particularly congested, as already-strained hospitals dealt with a crush of COVID patients.

Those figures, for a 10-month period ending in February, are contained in the most-recent report cards self-reported by Fraser Health. (You can read more about those report cards here.) And while the slow admittance rates were blamed on the pandemic, the situation is only slightly worse than pre-2020.

Four times a year, Fraser Health issues the report cards, which touch on a variety of issues, including the spread of infectious illnesses, hospital congestion, surgery waitlists, and the number of patients in hospital while awaiting care outside a hospital. They also outline what Fraser Health says it is doing to address shortfalls.

But while Fraser Health releases the data regularly to aid accountability, it has historically been little seen by the public. We want to give this valuable information to the public, so following each report card’s release, we’ll provide an update in the newsletter.

For clarity and simplicity, our synopsis is significantly more generalized than the range of data reported in the report cards, which measure dozens of different factors.

Below the figures, we will define what each measure means and the data it uses.

Note: Our decision of where to distinguish between yellow, orange, and red levels when a hospital fails to meet a target is admittedly arbitrary. We provided more room before reaching the orange and red levels for discharge waits because of the high level of variability between institutions catering to different populations. Similarly, we used a narrower scope for hospital deaths, because of the reduced variation between facilities.

Hospital deaths

This is based on the hospital’s Health Standardized Mortality Ratio (HSMR). The HSMR is the number of deaths at a facility compared to the number that could be expected to occur, given the illnesses a facility treats and the make-up of its patients. We previously wrote about the worryingly high HSMR at Abbotsford Regional Hospital.

As the name indicates, the HSMR is a ratio, based on the number of deaths to the number of expected deaths. A high HSMR can be attributed to in-hospital risks. It’s also possible that it can reflect a hospital’s unique population. That is likely partially the case at Mission Memorial Hospital, where only certain types of patients are admitted, and more serious cases are transferred to Abbotsford Regional Hospital. It’s also possible that could have an impact on Abbotsford’s HSMR, although when The Current asked Fraser Health about that facility’s HSMR figures last year, health officials did not mention that possibility. [LINK]

It’s also conceivable the same dynamic could influence the HSMRs of Fraser Canyon Hospital in Hope and Chilliwack General Hospital.

Green: better than 93

Yellow: Above target by 5% or less (93.01 – 97.65)

Orange: 5% and 10% of target (97.66 – 102.3)

Red: Above 10% of target (102.31 and up)

Click for the report card

Acquired illness

Being in hospital itself carries some degree of risk. Fraser Health tracks six different illnesses that can be acquired within health facilities. Those are: Clostridioides difficile (C. diff/CDI); Methicillin-resistant staphylococcus aureus (commonly MRSA/staph infection); sepsis; acquired delirium (the deterioration of physical and cognitive functioning); acquired pneumonia; and urinary tract infections.

Of those six illnesses, we list how many targets each facility is achieving.

Green: Achieving 5 or 6 meeting targets

Yellow: Achieving 4 targets

Orange: Achieving 2 or 3 targets

Red: Achieving 0 or 1 targets

Click for the report card

ER congestion

This uses Fraser Health’s measure of “emergency patients admitted to hospital within 10 hours.” This is a measure not of how long it takes to get seen in an emergency room (Fraser Health does not provide data on that, unlike some other health authorities), but how long it takes those who need to be admitted to be moved out of the emergency room. It is partly a measure of hospital capacity. When a hospital has no free beds, those who are admitted end up waiting in the ER. Even pre-COVID, BC’s hospitals have been operating above 100% capacity for years, with the Fraser Valley’s hospitals being some of the most congested.

Green: meets targets; 65% of inpatients are admitted within 10 hours of first entering the hospital.

Yellow: 10% or less below target (58.5% – 65%)

Orange: Between 10% and 30% below target (45.5% – 58.5%)

Red: More than 30% below target (fewer than 45.5% of patients are not admitted within 10 hours)

Click for the report card

Surgery waits

This uses Fraser Health’s measure of the number of scheduled non-emergency surgeries that are completed within 26 weeks. Such surgeries are not performed in Mission and Hope.

Green: Achieves target; 95% or more of non-emergency surgeries completed within 26 weeks

Yellow: 10% or less below target (85.5% – 95%)

Orange: Between 10% and 30% below target (66.5% – 85.5%)

Red: More than 30% below target (below 65.5%)

Click for the report card

Discharge waits

So-called “alternate level of care” patients are a perennial cause of hospital congestion. These are patients who don’t need to be in hospital and could be cared for in the community, either through a home health program or in a residential care facility. This, then, measures health care capacity in the community, where health authorities say care can be safer, more comfortable for patients, and more cost-effective.

Our “discharge waits” category uses Fraser Health’s measure of “alternate level of care days” for each hospital. Fraser Health says this is a measure of how many “extra” days patients spend in hospital when they no longer need hospital treatment. The measure is actually not the number of days each patient spends, but a ratio comparing the number of expected days in hospital to the actual length of time spent in hospital.

This figure has improved significantly through the pandemic. Some of that can be traced to initiatives to free up space in BC’s hospitals to make room for an influx of COVID patients. Unfortunately, high numbers of deaths in local long-term care facilities will also have resulted in more beds being available than would otherwise be expected.

Green: Achieves target; patients spend an average of 12.9% longer in hospital than expected

Yellow: 20% above target (12.9% – 15.5%)

Orange: Between 20% and 50% above target (15.5% to 19.4%)

Red: More than 50% above target (more than 19.4%)

Click for the report card