GTA nursing below average
Pressure ulcers, in-hospital fractures, among ’adverse events’ used to measure performance
Nurses could be doing a better job at half of hospitals in the Greater Toronto Area, according to an analysis of patient safety data.
Half of the 18 acute-care hospitals in the Greater Toronto Area fall below the national average on measures relating to nursing care.
Known as “nursing-sensitive adverse events,” they include urinary tract infections, pressure ulcers, inhospital fractures and pneumonia.
The measurements are contained in a report by the Canadian Institute for Health Information, or CIHI, which looks at adverse events for both medical and surgical patients in 2010-2011.
Of 18 hospitals, including both community and teaching facilities, York Central has the highest level of problems relating to nursing care for medical patients.
For every1,000 patients, 43 end up with urinary tract infections, pressure ulcers, in-hospital fractures or pneumonia.
The University Health Network has the highest level of nursing-sensitive adverse events for surgical patients, with 53 per 1,000 patients running into trouble.
The University Health Network, which includes Toronto General, Toronto Western, Princess Margaret and Toronto Rehab, performs some of the most complicated and high-risk surgeries in Canada, such as transplants.
Kira Leeb, director of health system performance at CIHI, explained that adverse events ideally should not happen in hospital, but when they do, it is likely more related to nursing care than, for example, physician care. For instance, urinary tract infections can be caused by poor hand hygiene, pressure ulcers can develop when patients are not turned frequently enough, elderly patients can fall and fracture hips when not closely monitored and pneumonia can develop when patients are not encouraged to get out of bed and move around. “It doesn’t necessarily mean that a nurse made a mistake in any way, shape or form, it just means there are some aspects of care that nurses could be paying more attention to,” Leeb said. In a Star analysis of the data that looked at GTA hospitals below the national average for nursing care, Trillium Health showed the lowest number of adverse events for medical patients, with 20 per 1,000 pa- tients last year. Southlake Regional had the lowest level for surgical, with 25 per 1,000 patients. In assessing patient safety, CIHI also looked at in-hospital hip fractures in the elderly. This could result from, for example, a patient falling when going to the bathroom. GTA hospitals did well on this count, with only four of18 GTA hospitals worse than the national average. Another measure of patient safety is injuries new mothers sustain while giving birth, specifically fourth-degree perineal tears. Hospitals keep track of the number of women who sustain tears during vaginal births, with or without the assistance of instruments like forceps or vacuums. GTA hospitals also did well here. Only five of 17 GTA hospitals that measure this indicator did worse than the national average.