Hospital Standardized Mortality Ratio (HSMR)
From April 2015 to March 2016, the overall HSMR for Hamilton Health Sciences was 102.
What is "Hospital Standardized Mortality Ratio"?
- The hospital standardized mortality ratio compares the number of deaths in a hospital with the national average of 100 for the baseline year 2012–2013.
- HSMR is an overall quality indicator that compares a hospital's mortality rate with the national average, accounting for the types of patients cared for. It has been used by many hospitals worldwide to assess and analyze mortality rates and to identify areas for improvement.
- HSMR is calculated as the ratio of the actual number of deaths to the expected number of deaths, multiplied by 100.
- It is based on diagnosis groups that account for 80% of all deaths in acute care hospitals, and is adjusted for factors such as diagnosis group, age, sex, length of stay, admission category, co-morbidities, and transfers.
- A ratio equal to 100 is interpreted as no difference between a hospital’s mortality rate and the average rate of the baseline year.
- A ratio greater than 100 indicates that a hospital’s mortality rate is higher than the average rate of the baseline year.
- A ratio of less than 100 indicates that a hospital’s mortality rate is lower than the average rate of the baseline year.
How are hospitals using HSMR data to help reduce mortality rates and make improvements?
- HSMR has been used by hospitals in several countries to assess in-hospital mortality rates and to help organizations identify areas for improvement. HSMR should be used as a tool to help follow progress over time, and make quality improvements based on the results. That said, we recognize there is always more to do to make the care we provide better, timelier and safer. Patients should know that their hospital is safe, that the care they receive there is top-notch, and that every effort is to ensure they receive the highest-quality care possible.
- Ontario hospitals are using the HSMR for internal benchmarking purposes. Annually reported data helps to show hospitals how their HSMR has changed, where they have made progress, and where they can continue to improve.
Each year, we carefully review the results, identify and work to implement improvements wherever possible. This year will be no exception.
Interpreting the Hospital Standardized Mortality Ratio Reports
- HSMR can be a very effective quality improvement tool. It should be seen as a system-level measure, and not focused on individuals. A higher than average HSMR result does not necessarily mean that a hospital is "unsafe" just as a lower than average HSMR does not necessarily mean a hospital is "safe." It is vital that HSMR results be viewed in the context of other performance indicators.
- The HSMR tool is not intended to serve as a measure for hospitals to compare themselves against other organizations, or for the public to use as a measure of choosing where to seek care.
- We strongly support the public reporting of quality indicators such as HSMR because we believe it will inspire improved performance, enhance patient safety, and strengthen the public’s confidence in Ontario’s hospitals.
- It is important to note that hospitals – even within a region – often serve different segments of the population with different health needs. That’s perhaps one reason why our hospital scored differently than another in our LHIN.
HSMR: Our Current Year's Results for Hamilton Health Sciences (HHS)
- From April 2016 to March 2017, the overall HSMR for Hamilton Health Sciences was 109. Although it seems the HSMR has increased recently, it is important to note that 2014-15 included the data for West Lincoln Memorial Hospital as well, so performance in 2014-15 represents the new baseline for HHS. Of note, CIHI excludes Children’s Hospitals from the HSMR calculation and so the HHS HSMR is based on Hamilton General hospital, Juravinski hospital, and most recently West Lincoln Memorial Hospital.
What are we doing to continue to improve our HSMR rate at Hamilton Health Sciences?
Under the Excellent Care for All Act, hospitals are required to develop a Quality Improvement Plan (QIP) that outlines clear objectives for improving patient care. This year’s QIP (2017/18) is also publicly posted, so it’s one more way we are staying accountable to our community, patients and staff and being openly committed to improving the care we provide. HSMR is a key indicator that is considered each year in the formation of the QIP. Recently Health Quality Ontario has removed HSMR from its list of core indicators for Quality Improvement Plans.
One of the ongoing ways in which Hamilton Health Sciences identifies opportunities to improve care processes is to review a random sample of deaths that occur at HHS. HHS also has many other quality of care initiatives underway that will result in safer care. Some of these initiatives include:
- Enhancing patient safety culture by spreading patient safety practices – 3 key practices have been implemented over the last several years: safety huddles (short team briefings that identify and discuss strategies to ensure safe care for patients), openly displayed quality indicators to ensure staff know how they are doing and where opportunities for improvement may lie, and implementation of purposeful hourly rounding to enhance communication.
- Improving patient safety by increasing the proportion of patients with medication reconciled upon admission to hospital – when admitting patients to hospitals, it is very important to ensure that accurate medication lists are captured and match admission orders. HHS has taken steps to safeguard patients against medication errors.
- Patient Safety Leadership Walk-arounds
- Hand Hygiene Improvement initiatives
- Reducing pressure ulcers
- Safe surgery checklist
- Improvements aimed at preventing patients from developing sepsis
- Preventing ventilator associated pneumonia and central line infections
- Improving access to care and services
HHS has also joined the American College of Surgeons National Surgical Quality Improvement Program aimed at enhancing surgical quality