Hamilton Health Sciences
Achieving excellence in care, research & education

 Hospital Standardized Mortality Ratio (HSMR)

From April 2013 to March 2014, the overall HSMR for Hamilton Health Sciences was 86.

What is "Hospital Standardized Mortality Ratio"?

  • The hospital standardized mortality ration compares the number of deaths in a hospital with the national average of 100 from the baseline year 2009-2010
  • HSMR is an overall quality indicator that compares a hospital's mortality rate with the average national experience, 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 that is equal to 100 is interpreted as no difference between the hospital's mortality rate and the average national rate of the baseline year.  
  • A ratio greater than 100 indicates that the hospital's mortality rate is higher than the average national rate of the baseline year.
  • A ratio less than 100 indicates thata  hospital's mortality rate is lower than the average national 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.
  • Trending HSMR results for several years has proven very useful: stable reporting year after year helps show how our HSMR has changed in relation to our quality improvement efforts – where we’ve made progress and where we 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 2013 to March 2014, the overall HSMR for Hamilton Health Sciences was 86.  This continues the improvement HHS has seen over the last several years.  Since the ratio is less than 100, tha actual overall mortality rate is lower than the expected overall mortality rate.




 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 (2014/15) is also publically posted, so it is 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.

One of the ongoing ways in which Hamilton Health Sceinces 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 implemented in 2013:  Safety huddles (short term 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
  • Improving access to care and services
  • Safe Surgery Checklist
  • Preventing ventilator associated pneumonia and Central LIne infections
  • HHS has also recently joined the American College of Surgeons National Surgical Quality Improvement Program aimed at enhancing surgical quality
Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

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