Nova Scotia Health officials are reviewing data showing a higher death rate after a common heart surgery procedure compared to the national average.
This summer, The Canadian Institute for Health Information (CIHI) released its latest Cardiac Care Quality Indicators report. The document reviewed three years of data from hospitals across the country, considering six outcome indicators. Risk-adjusted results are obtained from this work.
Although outcomes from the cardiac surgery program at the Queen Elizabeth II Health Sciences Center in Halifax were within the national average for five of the categories, their outcome for in-hospital mortality at 30 days after bypass graft surgery Isolated coronary artery disease, or CABG, was considered statistically significant.
Sunita Karmakar-Hore, manager of the health system performance reporting team at CIHI, said the results are considered statistically significant when both the upper and lower confidence intervals for the risk-adjusted rates fall above or below the national average. The national average 30-day hospital mortality after isolated CABG is 1.5 deaths per 100 patients. CIHI found the range in Halifax to be between 2.3 and 4.6.
‘It’s really a flag’
Karmakar-Hore said hospital officials should pay attention to their data if a result is statistically significant, particularly if it’s going in an unfavorable direction.
“It’s really a flag for the hospital to dig into their data to really understand what’s going on with the care of those patients and to understand if there could be process or quality improvements that could be made to improve the outcome,” he said. . she told her in a recent interview.
Dr. Gail Darling, chair of Dalhousie University’s department of surgery and chief of the health authority’s central zone surgery department, said officials are doing that job now.
Darling said he understands why people might have concerns when they hear negative things about the health care system, but the important thing for the public to know is that the results are being investigated.
“I don’t think alarm bells should be ringing, by any means, but we should never ignore any of these signals,” he said in an interview.
Darling said results have been good in the past and officials will look at why that appears to have changed. Coronary artery bypass graft surgery is a procedure used to treat coronary artery disease by bypassing a blockage by using a piece of a healthy blood vessel from another part of the patient’s body. About 400 of them are held each year in Halifax.
Although the CIHI data are risk-adjusted, Darling said they don’t account for all variables. She said the hospital’s own database incorporates other factors that she believes more accurately reflect the risk profile of the site’s patients.
With that accounting, Darling said the results of the procedure at QEII are “actually pretty good, and actually better than expected based on the types of patients we have.”
Patients are ‘sharper, sicker’
Nova Scotia has a high proportion of smokers, diabetics and people who are overweight, all of which contribute to risk factors for patients, Darling said. More than half of the patients who get the procedure in Halifax are inpatients, meaning they have come in with symptoms, have been investigated and are sick enough to have to stay in the hospital and wait for surgery, Darling said.
The statistic is around 30 percent in the rest of Canada, he said.
“For us, it’s probably closer to 60 percent,” Darling said. “So these patients really are sharper, sicker.”
A CIHI spokesperson said the report serves as an important first step in measuring and improving cardiac care in Canada. The selection of risk factors and indicators was based on input from an expert advisory group that included representatives from the Canadian Association of Interventional Cardiology and the Canadian Society of Cardiac Surgeons.
Darling said the hospital would look at individual surgeons’ results to determine if there is a widespread problem or if there are outliers.
The Effects of the Workplace on Outcomes
Health officials in Halifax reviewing the results do so as the cardiac surgery department is undergoing an external review.
That follows ongoing reports of misbehavior by some members of the unit, including surgeons. Past The division’s reviews have indicated a lack of progress in ending the destructive behavior. and the inability to introduce a toothy code of conduct.
Darling acknowledged that such issues can have an effect on performance in a field that “really requires a high-performance team.”
“We know from the business literature that high-functioning teams have the best results,” he said, adding that “psychological safety” is a key factor in those results.
“That’s definitely a question for us based on those historical reviews. The question is whether it’s still an ongoing issue and we’re going to find out more once we get the results of that big external review.”
That work is expected to be completed by the end of the month, he said.