Measures of Hospital Safety are Incomplete

In an early release article viewpoint the Canadian Medical Association Journal (CMAJ) has criticized the usefulness of data collected by the the Canadian Institute for Health Information (CIHI). The CIHI has been operating since 1994. It is effectively a partnership of federal and provincial governments. Its mandate is to develop and maintain databases of comprehensive and integrated health information. The information is to be used to assist in creation of health policy and to improve health system management. The ultimate goal is improved health care for Canadians.

The main criticism is that CIHI is not measuring hospital-acquired infection rates. This is a sensitive topic as Canada has one of the worst hospital infection rates (11.6%) among developed countries, according to a 2011 World Health Organization report on the burden of endemic health care-associated infections. By contrast, the WHO reports that Germany’s rate is 3.6%, while that of France is 4.4%. The article argues that any accurate measure of patient safety within Canadian hospitals should include hospital-acquired infection rates.

Another important indicator that CIHI is not tracking is the rate of medication error within hospitals. According to Linda Wilhelm of the Best Medicines Coalition by current estimates only 1% to 10% of adverse drug reactions are reported in Canada. Medication errors and reactions should be tracked in measuring hospital performance given the fact that medication errors and adverse drug reactions represent a significant cost to the health care system. We have already commented on the important topics of medication error and adverse drug reactions on our compensation for medication errors page.

The rather lame response of the CIHI to these criticisms is that “the relative lack of clinical detail within administrative data and coding irregularities continue to pose an obstacle to compiling comparable statistics on patient safety.” As CIHI approaches its twentieth anniversary one would think that it has had ample time to develop standards for the collection of infection rates and incorrect administration of medication.