Why are so many people dying in Abbotsford’s hospital?

A key measure of the mortality rate at Abbotsford Regional Hospital remains high despite previous predictions that resolving “documentation errors” would dramatically lower the key figure.

The hospital’s mortality rate has been higher than other large Fraser Health facilities for three years now, with no explanation for why. In May, the hospital’s top executive told The Current he was optimistic that ARH’s Hospital Standardized Mortality Ratio would be considerably lower when new figures were released. But those statistics are now out, and the hospital’s standardized death rate remains the worst in the region, and significantly above what it was four years ago. (Calculations for the HSMR do not include deaths related to COVID.)

Experts say the rate should be considered along with other key safety metrics, given each hospital’s unique patient demographics. But on those too, the hospital continues to fall short. Meanwhile, a major Canadian health data organization has just published a study revealing the frequency at which patients sustain harm in the country’s hospitals.

A measure of hospital safety

The Hospital Standardized Mortality Ratio (HSMR) compares the number of deaths in a hospital with the number that would be expected based on the patients and types of patients a facility treats. In the latest statistics released by Fraser Health for the 2020/21 year, Abbotsford’s HSMR is 116, well above both other similar hospitals in the Lower Mainland; it has also had the highest HSMR among large Fraser Health hospitals for three years. And while that isn’t automatically bad, according to experts, the fact that the rate is much higher than four years ago and is accompanied by other worrying statistics could be a sign of trouble.

The HSMR and other safety statistics are collected and published because they are a key way to measure hospital danger. While people go to hospital because they are already suffering from an injury or illness, being in a hospital itself also exposes a person to risk. The Canadian Institute for Health Information published a study showing just how frequently people suffer unintended harm in hospitals across Canada.

“I think people are surprised to learn that one in 17 hospital admissions end up with some form of harm that impacts care,” Josée Davidson said. Harms can include sepsis, infections, falls, and medical incidents.

The HSMR helps officials and observers track the quality of care in a hospital, especially over time, according to Mélanie Josée Davidson, director of health system performance at CIHI, which also publishes data for nearly every public hospital and health system in the country.

The HSMR allows hospitals to predict the death rate they should expect to see, based on the patients in its hospital and the rate of death for others. “Really what you want to be looking at is how are you progressing over time, because each hospital has a different patient composition and we cannot account for all of the factors,” Josée Davidson said

And Abbotsford Regional’s mortality rate has not always been so high. Between 2015 and 2018, the HSMR dropped by around 10%. But the gains in Abbotsford reversed themselves in a single year, even as mortality rates dropped across the rest of Fraser Health. The HSMR jumped from 104 to 116 in 2018-19 and has remained high ever since.

Josée Davidson said the measure should be read along with other indicators. But on those too, Abbotsford Regional continues to struggle, both according to CIHI measures and those published quarterly by Fraser Health.

Of 12 indicators measured by CIHI for 2019-20—ranging from the sepsis rates to the time spent in emergency room prior to admission—ARH was below average on four and above average on none.

Fraser Health tracks even more numbers for each facility, and its most recent facility report card in September 2021, Abbotsford Regional’s rates of the bacterium C. difficile, MRSA (a cause of staph infections), acquired delirium, urinary tract infections, and non-aspiration pneumonia were all higher than Fraser Health’s targets. (Of quality and safety measures, only ARH’s sepsis numbers beat Fraser Health’s target.)

See the latest report card for your local hospital: Langley | Abbotsford | Mission | Chilliwack | Hope (Fraser Canyon) | All of Fraser Health

After two years, few new answers

Since this reporter first asked about the hospital’s HSMR nearly two years ago, officials have said they have been trying to reduce the rate and improve patient safety.

The Current again asked the person in charge of Abbotsford Regional Hospital, executive director Brendan Abbott, about the mortality rate in the spring.

Abbott said then that the hospital had “a number of projects” looking at the figures and how to improve them. Those included safety measures like physician discharge templates, and also a review of cases to see if the reason for the elevated HSMR lay in documentation errors or filing errors.

“We’re confident that when the next round of results come out, we will see some very different results,” Abbott said at the time.

On Oct. 25, The Current asked Fraser Health about whether it still believes data errors are behind the elevated death rate and, if the rate is accurate, what is being done to improve safety. The Current also asked for an interview about the high rates. Ten days later, on Nov. 4, a spokesperson replied to a follow-up inquiry by saying the health authority was still working on the inquiry. On Nov. 11, just prior to the publication of this article, Fraser Health provided a written response that didn’t touch on the data errors suggested in the spring, but again expressed confidence that the HSMR would decrease in the future.

In the response, a spokesperson wrote: “We are actively working to address the HSMR rate at Abbotsford Regional Hospital, including reviewing patient cases and making changes to our documentation processes that more accurately reflect the complexity of the patients we serve at the hospital and their journey of care. While the cumulative impact of these improvements to our processes will take time to be fully realized, we are confident that they will be reflected in future data releases.

“We have also undertaken a number of initiatives at Abbotsford Regional Hospital to improve quality outcomes for patients including improving access, patient flow and health outcomes by adding additional beds, expanding the emergency department, strengthening our partnership with Mission Memorial Hospital, and increasing oversight on managing complex care cases and barriers to patients.”

That statement was almost identical to one issued two years ago, when Fraser Health cited new beds, an expanded emergency department, increased complex care oversight and “strengthening the partnership with Mission Memorial Hospital,” as some of its work to improve care.

No one was made available for an interview.