Background
Methods
Study design and setting
Hospital selection
Case selection
Statistical analysis
Characteristics of the institutions and patients
ED-HSMR calculation
Expected deaths
Hospital-level and aggregated provincial ED-HSMRs
Results
Characteristics of cases and hospitals
Median Age (IQR) | 73 (59–83) |
---|---|
Male | 673,102 (50.4) |
Charlson score | |
0 | 852,794 (63.9) |
1 | 226,960 (17.0) |
2 | 139,624 (10.5) |
3 | 59,522 (4.5) |
4 | 17,885 (1.3) |
≥ 5 | 38,594 (2.9) |
Median In-hospital length of stay [days (IQR)] | 5 (3–11) |
Transfer from another acute care facility to ED | 35,290 (2.6) |
In-hospital deaths | 118,649 (8.9) |
Hospital peer-groups | |
Teaching | 326,585 (24.5) |
Community - Large | 583,776 (43.7) |
Community - Medium | 280,549 (21.0) |
Community - Small | 144,469 (10.8) |
Provinceb | |
Ontario | 542,335 (40.6) |
Québec | 210,914 (15.8) |
British Columbia | 195,956 (14.7) |
Alberta | 140,809 (10.5) |
Saskatchewan | 59,019 (4.4) |
Manitoba | 55,921 (4.2) |
New Brunswick | 44,236 (3.3) |
Nova Scotia | 44,001 (3.3) |
Newfoundland and Labrador | 30,277 (2.7) |
Prince Edward Island | 7661 (0.6) |
Territories | 4250 (0.3) |
Province | Teaching | Community-Large | Community-Medium | Community-Small |
Total
|
---|---|---|---|---|---|
Newfoundland and Labrador | 1 (3.5) | 0 (0) | 5 (17.2) | 23 (79.3) | 29 |
Prince Edward Island | 0 (0) | 1 (20.0) | 1 (20.0) | 3 (60.0) | 5 |
Nova Scotia | 1 (3.1) | 1 (3.1) | 8 (25.0) | 22 (68.8) | 32 |
New Brunswick | 1 (5.0) | 4 (20.0) | 5 (25.0) | 10 (50.0) | 20 |
Québec | 16 (17.0) | 24 (25.5) | 28 (29.8) | 26 (27.7) | 94 |
Ontario | 13 (8.1) | 35 (21.9) | 38 (23.8) | 74 (46.3) | 160 |
Manitoba | 2 (3.4) | 5 (8.5) | 7 (11.9) | 45 (76.3) | 59 |
Saskatchewan | 5 (8.3) | 0 (0) | 6 (10.0) | 49 (81.7) | 60 |
Alberta | 3 (3.2) | 8 (8.6) | 6 (6.5) | 76 (81.7) | 93 |
British Columbia | 2 (2.8) | 15 (21.1) | 20 (28.2) | 34 (47.9) | 71 |
Territories | 0 (0) | 0 (0) | 2 (33.3) | 4 (66.7) | 6 |
Total
| 44 | 93 | 126 | 366 | 629 |
Overall and diagnosis group specific mortality rates
Diagnosis Groups included in the ED-HSMR | No of Patients | % of Patients | Number of deaths | Mortality rate (%) | Mortality rate 95% CI | ||
---|---|---|---|---|---|---|---|
J44 | Other chronic obstructive pulmonary disease | 172,451 | 12.9 | 11,828 | 6.9 | 6.7 | 7.0 |
J18 | Pneumonia | 137,704 | 10.3 | 11,674 | 8.5 | 8.3 | 8.6 |
I50 | Heart failure | 130,597 | 9.8 | 13,393 | 10.3 | 10.1 | 10.4 |
I21 | Acute Myocardial Infarction (AMI) | 121,463 | 9.1 | 8983 | 7.4 | 7.2 | 7.5 |
S72 | Fracture of femur | 81,591 | 6.1 | 4325 | 5.3 | 5.1 | 5.5 |
K56 | Paralytic ileus and intestinal obstruction without hernia | 69,397 | 5.2 | 2558 | 3.7 | 3.5 | 3.8 |
I63 | Cerebral infarction | 50,987 | 3.8 | 6472 | 12.7 | 12.4 | 13.0 |
K85 | Acute pancreatitis | 46,149 | 3.5 | 714 | 1.5 | 1.4 | 1.7 |
E11 | Diabetes Mellitus type 2 | 43,269 | 3.2 | 1672 | 3.9 | 3.7 | 4.0 |
L03 | Cellulitis | 41,177 | 3.1 | 645 | 1.6 | 1.4 | 1.7 |
A41 | Sepsis | 40,769 | 3.1 | 10,198 | 25.0 | 24.6 | 25.4 |
K57 | Diverticular disease of intestine | 38,133 | 2.9 | 633 | 1.7 | 1.5 | 1.8 |
K92 | Other diseases of digestive system | 34,946 | 2.6 | 1639 | 4.7 | 4.5 | 4.9 |
N17 | Acute renal failure | 31,631 | 2.4 | 3612 | 11.4 | 11.1 | 11.8 |
S06 | Intracranial injury | 29,756 | 2.2 | 3294 | 11.1 | 10.7 | 11.4 |
E87 | Other disorders of fluid, electrolyte and acid-base balance | 25,760 | 1.9 | 690 | 2.7 | 2.5 | 2.9 |
S32 | Fracture of lumbar spine and pelvis | 24,063 | 1.8 | 681 | 2.8 | 2.6 | 3.0 |
I64 | Stroke, not specified as haemorrhage or infarction | 23,687 | 1.8 | 3328 | 14.0 | 13.6 | 14.5 |
I26 | Pulmonary embolism | 23,237 | 1.7 | 1335 | 5.7 | 5.4 | 6.0 |
J69 | Pneumonitis due to solids and liquids | 20,131 | 1.5 | 5747 | 28.5 | 27.9 | 29.2 |
F05 | Delirium, not induced by alcohol and other psychoactive substances | 20,038 | 1.5 | 1215 | 6.1 | 5.7 | 6.4 |
I24 | Other acute ischemic heart disease | 17,864 | 1.3 | 606 | 3.4 | 3.1 | 3.7 |
E86 | Volume depletion | 13,475 | 1.0 | 634 | 4.7 | 4.3 | 5.1 |
J96 | Respiratory failure, not elsewhere classified | 12,351 | 0.9 | 4365 | 35.3 | 34.5 | 36.2 |
K55 | Vascular disorders of intestine | 11,554 | 0.9 | 1791 | 15.5 | 14.8 | 16.2 |
K26 | Duodenal ulcer | 10,964 | 0.8 | 565 | 5.2 | 4.7 | 5.6 |
I61 | Intracerebral haemorrhage | 10,783 | 0.8 | 3440 | 31.9 | 31.0 | 32.8 |
T82 | Complications of cardiac and vascular prosthetic devices, implants and grafts | 9182 | 0.7 | 362 | 3.9 | 3.5 | 4.3 |
K72 | Hepatic failure | 7040 | 0.5 | 1231 | 17.5 | 16.6 | 18.4 |
I62 | Other non traumatic intracranial haemorrhage | 5467 | 0.4 | 1141 | 20.9 | 19.8 | 21.9 |
K65 | Peritonitis | 5433 | 0.4 | 450 | 8.3 | 7.5 | 9.0 |
R57 | Shock, not elsewhere classified | 5130 | 0.4 | 2566 | 50.0 | 48.7 | 51.4 |
I71 | Aortic aneurism and dissection | 5033 | 0.4 | 1277 | 25.4 | 24.2 | 26.6 |
I60 | Subarachnoid haemorrhage | 4797 | 0.4 | 1043 | 21.7 | 20.6 | 22.9 |
G93 | Other disorders of brain | 4179 | 0.3 | 1648 | 39.4 | 38.0 | 40.9 |
I46 | Cardiac arrest | 3582 | 0.3 | 2331 | 65.1 | 63.5 | 66.6 |
J80 | Adult respiratory distress syndrome | 1609 | 0.1 | 563 | 35.0 | 32.7 | 37.3 |
All conditions | 1,335,379 | 100.0 | 118,469 | 8.9 | 8.8 | 8.9 |
Hospital-level ED-HSMRs
2010 | 2011 | |||||
---|---|---|---|---|---|---|
< 100
|
> 100
|
Total
|
< 100
|
> 100
|
Total
| |
Peer-Groups | ||||||
Teaching | 14 (33.3) | 6 (14.3) | 42 | 11 (44.0) | 1 (4.0) | 25 |
Large Community | 31 (33.3) | 8 (8.6) | 93 | 35 (50.7) | 2 (2.9) | 69 |
Medium Community | 22 (18.0) | 10 (8.2) | 122 | 18 (18.9) | 9 (9.5) | 95 |
Small Community | 0 (0) | 7 (18.9) | 37 | 3 (12.5) | 3 (12.5) | 24 |
Provinces | ||||||
Newfoundland/Labrador | 0 (0) | 5 (71.4) | 7 | 0 (0) | 4 (50.0) | 8 |
Prince Edward Island | 0 (0) | 0 (0) | 2 | 0 (0) | 0 (0) | 2 |
Nova Scotia | 0 | 5 (71.4) | 7 | 0(0) | 2 (20.0) | 10 |
New Brunswick | 3 (27.3) | 0 (0) | 11 | 4 (36.4) | 0 (0) | 11 |
Québeca | 19 (25.3) | 9 (12.0) | 75 | N/A | N/A | N/A |
Ontario | 24 (22.3) | 9 (8.3) | 105 | 38 (39.6) | 6 (6.3) | 96 |
Manitoba | 0 (0) | 0 (0) | 12 | 0 (0) | 1 (8.3) | 12 |
Saskatchewan | 3 (25.0) | 1 (8.3) | 12 | 4 (33.3) | 1 (8.3) | 12 |
Alberta | 7 (38.9) | 2 (11.1) | 18 | 6 (30.0) | 1 (5.0) | 20 |
British Columbia | 11 (28.2) | 0 (0) | 39 | 15 (36.6) | 0 (0) | 41 |
Territoriesb | 0 (0) | 0 (0) | 0 | 0 (0) | 0 (0) | 1 |